Handling of patient&#39;s own medicine systems, methods, and devices

ABSTRACT

Systems, methods, and devices are described related to the assignment and management of patient-specific bins. A dispensing device at a healthcare facility includes a number of bins for storage of medical supplies, with some of the bins designated as patient-specific bins allocated to be assigned to patients for storage of their medications or certain other supplies. A central server computer system, in communication with a computer of the dispensing device, may monitor and assign current and future patient-specific use of the bins for the dispensing device. The assignment and management of patient-specific bins may be performed by devices distributed through the system.

CROSS-REFERENCE

This Application claims priority from the following U.S. ProvisionalPatent Applications: U.S. Patent Application No. 60/944,995, filed onJun. 19, 2007, entitled “PATIENT-SPECIFIC BINS”, and U.S. PatentApplication No. 60/991,547, filed on Nov. 30, 2007, entitled“PATIENT-SPECIFIC BIN SYSTEMS, METHODS, AND DEVICES”. This applicationis related to the following U.S. patent applications: U.S. patentapplication Ser. No. 12/140,964, filed concurrently herewith, entitled“PATIENT-SPECIFIC BIN SYSTEMS, METHODS, AND DEVICES”, U.S. patentapplication Ser. No. 12/140,966, filed concurrently herewith, entitled“STATUS DESIGNATION FOR DISPENSING DEVICE SYSTEMS AND METHODS”, U.S.patent application Ser. No. 12/140,969, filed concurrently herewith,entitled “PATIENT-SPECIFIC BIN ASSIGNMENT SYSTEMS, METHODS, ANDDEVICES”, U.S. patent application Ser. No. 12/140,970, filedconcurrently herewith, entitled “MANAGEMENT OF PATENT TRANSFER SYSTEMS,METHODS, AND DEVICES”; U.S. patent application Ser. No. 12/140,971,filed concurrently herewith, entitled “REMOVAL OR RETURN OF ITEMSASSOCIATED WITH A PATIENT-SPECIFIC BIN SYSTEMS AND METHODS”, U.S. patentapplication Ser. No. 12/140,975, filed concurrently herewith, entitled“IDENTIFYING ITEMS FOR RESTOCKING OF A DISPENSING DEVICE SYSTEMS ANDMETHODS”, U.S. patent application Ser. No. 12/140,979, filedconcurrently herewith, entitled “BIN ALLOCATION SYSTEMS, METHODS, ANDDEVICES”, and U.S. patent application Ser. No. 12/140,985, filedconcurrently herewith, entitled “HANDLING OF MULTI-USE ITEM SYSTEMS,METHODS, AND DEVICES”. This application hereby incorporates by referenceherein the content of the aforementioned applications in their entiretyand for all purposes.

BACKGROUND

The present invention in general relates to managing the storage anddistribution of medications and other medical supplies at a healthcarefacility and, in particular, to patient-specific bins.

At many healthcare facilities, it may be beneficial for items to beavailable for use at specific locations. For example, in hospitals,practitioners may find it convenient to place medications (includingpharmaceuticals) and other supply items near where patients are beingtreated. A nursing station is one such location, as nurses may find itmore efficient to have certain medications readily available. Dependingon the type of items to be dispensed, the environment where the itemsare to be used, and the like, a variety of dispensing cabinets have beenemployed.

Typically, medications are placed in dispensing units which each store aspecific item to be used for a number of different patients. However,this type of storage configuration often leads to storage of supplies atmultiple locations, which may give rise to delivery inefficiencies. Thisitem-specific storage and distribution model may also give rise tobilling discrepancies and inventory control challenges. It wouldtherefore be beneficial to create systems, methods, or devices whichaddress one or more of the issues raised above, while still providingfor distributed storage of medications.

SUMMARY

Systems, methods, and devices are described for the storage anddistribution of medications and other supplies at a healthcare facility.A dispensing device (e.g., a cabinet) at the facility includes a numberof bins for storage of medications and other supplies, and some of thebins may be allocated as patient-specific bins available to be assignedfor patient-specific storage and dispensing functions.

A central server computer system, in communication with a computer ofthe dispensing device, may assign and monitor current and futurepatient-specific use of the bins for the dispensing device. Both thestocking and removal of items from patient-specific bins may be managedby the central server computer system. The central server computersystem may also manage the handling of medications and bin assignmentsduring the transfer or discharge of a patient. Management of multi-useitems and items brought to the healthcare facility by the patient isprovided for, as well.

A central dispensing unit, such as a pharmacy, may be in communicationwith the central server computer system and dispensing device computerto stock or restock the dispensing device at the appropriate levels. Insome embodiments, the assignment and management of patient-specific binsmay be performed by devices (e.g., the dispensing device) distributedthrough the system.

BRIEF DESCRIPTION OF THE DRAWINGS

A further understanding of the nature and advantages of the presentinvention may be realized by reference to the following drawings. In theappended figures, similar components or features may have the samereference label. Further, various components of the same type may bedistinguished by following the reference label by a dash and a secondlabel that distinguishes among the similar components. If only the firstreference label is used in the specification, the description isapplicable to any one of the similar components having the same firstreference label irrespective of the second reference label.

FIGS. 1A-1B are block diagrams illustrating various medical supplystorage and distribution systems including patient-specific binsconfigured according to various embodiments of the present invention.

FIG. 2 is a block diagram illustrating an alternative medical supplystorage and distribution system with patient-specific bins configuredaccording to various embodiments of the present invention.

FIG. 3 illustrates a front perspective of a cabinet dispensing deviceaccording to various embodiments of the invention.

FIG. 4 illustrates a drawer of a cabinet dispensing device includingpatient-specific and item-specific bins according to various embodimentsof the invention.

FIG. 5 illustrates a front perspective of an alternative cabinetdispensing device according to various embodiments of the invention.

FIG. 6 illustrates a perspective view of a drawer of a cabinetdispensing device according to various embodiments of the invention.

FIG. 7 illustrates a perspective view of a liner of a drawer of acabinet dispensing device according to various embodiments of theinvention.

FIG. 8 is a flow diagram illustrating a method of assigning bins fordispensing devices according to various embodiments of the invention.

FIG. 10 is a block diagram illustrating a system for status designationat dispensing devices according to various embodiments of the invention.

FIG. 11 is a block diagram illustrating an alternative system for statusdesignation at dispensing devices according to various embodiments ofthe invention.

FIG. 12 is a flow diagram illustrating a method of status designationfor dispensing devices according to various embodiments of theinvention.

FIG. 13 is a flow diagram illustrating an alternative method of statusdesignation for dispensing devices according to various embodiments ofthe invention.

FIG. 14 is a flow diagram illustrating yet another alternative method ofstatus designation for dispensing devices according to variousembodiments of the invention.

FIG. 20 is a diagram illustrating a reorder level and a target level foran item to be stored for a patient at a patient-specific bin at adispensing device according to various embodiments of the invention.

FIG. 21 is a flow diagram illustrating a method of identifying items ofa medication order to be reordered for a patient according to variousembodiments of the invention.

FIG. 22 is a flow diagram illustrating an alternative method ofidentifying items of a medication order to be reordered for a patientaccording to various embodiments of the invention.

FIG. 23 is a flow diagram illustrating an alternative method ofgenerating a restocking list for one or more cabinets according tovarious embodiments of the invention.

FIG. 24 is a flow diagram illustrating an alternative method ofdetermining reorder amounts according to various embodiments of theinvention.

FIG. 30 is a flow diagram illustrating a method of patient-specific binassignment according to various embodiments of the invention.

FIG. 31 is a flow diagram illustrating a method of bin assignmentaccording to various embodiments of the invention.

FIG. 32 is a flow diagram illustrating an alternative method ofpatient-specific bin assignment according to various embodiments of theinvention.

FIG. 33 is a flow diagram illustrating a method of identifying bins forpatient-specific bin assignment according to various embodiments of theinvention.

FIG. 40 is a block diagram illustrating a system for managingmedications during a patient transfer between rooms served by differentdispensing devices according to various embodiments of the invention.

FIG. 41 is a diagram of a table of bin configuration data that may bestored, analyzed, and transmitted according to various embodiments ofthe invention.

FIG. 42 is a flow diagram illustrating a method of managing a patienttransfers according to various embodiments of the invention.

FIG. 43 is a flow diagram illustrating a method of assigningpatient-specific bins at a dispensing device associated with thetransfer destination for a patient according to various embodiments ofthe invention.

FIG. 44 is a flow diagram illustrating an alternative method ofassigning patient-specific bins at a dispensing device associated withthe transfer destination for a patient according to various embodimentsof the invention.

FIG. 45 is a flow diagram illustrating a method of applying binconfiguration data to a dispensing device associated with the transferdestination for a patient according to various embodiments of theinvention.

FIG. 50 is a block diagram illustrating a system for removing and/orreturning medications stored or ready to be stored in a dispensingdevice which includes patient-specific bins according to variousembodiments of the invention.

FIG. 51 is a flow diagram illustrating a method of identifyingdiscontinued items from a PSB assigned to a patient according to variousembodiments of the invention.

FIG. 52 is a flow diagram illustrating an alternative method ofidentifying discontinued items from a PSB assigned to a patientaccording to various embodiments of the invention.

FIG. 53 is a flow diagram illustrating a method of identifying items forremoval from a PSB assigned to a patient according to variousembodiments of the invention.

FIG. 54 is a flow diagram illustrating a method of identifying items forremoval from a PSB assigned to a patient or for return according tovarious embodiments of the invention.

FIG. 60 is a block diagram illustrating a system for designating an itemas a patient's own medicine to be stored in a dispensing device whichincludes patient-specific bins according to various embodiments of theinvention.

FIG. 61 is a flow diagram illustrating a method of designatingmedication as a patient's own medication according to variousembodiments of the invention.

FIG. 62 is a flow diagram illustrating a method of designatingmedication to be returned to a patient according to various embodimentsof the invention.

FIG. 63 is a flow diagram illustrating a method of differentiatingbetween certain medications in the assignment of patient-specific binsaccording to various embodiments of the invention.

FIG. 64 is a flow diagram illustrating an alternative method ofdesignating medication as a patient's own medication according tovarious embodiments of the invention.

FIG. 65 is a flow diagram illustrating a method of managing medicationdesignated as a patient's own medication according to variousembodiments of the invention.

FIG. 70 is a flow diagram illustrating a method of managing the storageof multi-use items according to various embodiments of the invention.

FIG. 71 is a flow diagram illustrating a method of designating andstoring multi-use items according to various embodiments of theinvention.

FIG. 72 is a flow diagram illustrating a method of differentiating andmanaging multi-use items according to various embodiments of theinvention.

FIG. 73 is a flow diagram illustrating a method of managing medicationwith a multi-use designation through the patient life cycle according tovarious embodiments of the invention.

FIG. 80 is a block diagram illustrating a system for re-allocating binsaccording to various embodiments of the invention.

FIG. 81 is a flow diagram illustrating a method of allocating bins at adispensing device according to various embodiments of the invention.

FIG. 82 is a flow diagram illustrating a method of allocating bins at adispensing device based on current occupancy rates according to variousembodiments of the invention.

FIG. 83 is a flow diagram illustrating a method of allocating bins at adispensing device based on past occupancy rates according to variousembodiments of the invention.

FIG. 84 is a flow diagram illustrating a method of allocating bins at adispensing device based on future occupancy rates according to variousembodiments of the invention.

FIG. 85 is a flow diagram illustrating a method of allocating bins at adispensing device based on a combination of past, current, or futureoccupancy rates according to various embodiments of the invention.

FIG. 90 is a schematic diagram that illustrates a representative devicestructure that may be used in various embodiments of the presentinvention.

DETAILED DESCRIPTION

Systems, methods, and devices are described for storing and distributingmedications from a dispensing device which includes patient-specificbins. A dispensing device, such as a cabinet, includes a number of binsfor storing and dispensing medications. Some of the bins are allocatedto be assigned to a patient for exclusive use by the patient, and thesebins may be referred to herein as patient-specific bins. In contrast,item-specific bins of the dispensing device are bins allocated forstorage of one or more units of a medication independent of arelationship to a particular patient. The medication stored in such binsmay be available for use by a number of patients.

The following description provides example embodiments only, and is notintended to limit the scope, applicability, or configuration of theinvention. Rather, the ensuing description of the embodiments willprovide those skilled in the art with an enabling description forimplementing embodiments of the invention. Various changes may be madein the function and arrangement of elements without departing from thespirit and scope of the invention as set forth in the appended claims.

Thus, various embodiments may omit, substitute, or add variousprocedures or components as appropriate. For instance, it should beappreciated that in alternative embodiments, the methods may beperformed in an order different than that described, and that varioussteps may be added, omitted, or combined. Also, features described withrespect to certain embodiments may be combined in various otherembodiments. Different aspects and elements of the embodiments may becombined in a similar manner.

It should also be appreciated that any of the following systems,methods, devices, and software may be a component of a larger system,wherein other procedures may take precedence over or otherwise modifytheir application. Also, a number of steps may be required before,after, or concurrently with the following embodiments.

Referring to FIG. 1A, an example of a system 100 is illustrated forstoring and distributing medical supplies from a dispensing device whichincludes PSBs. The system 100 includes a dispensing device 120-a (e.g.,a cabinet with a number of bins) for dispensing medical supplies. Asused herein, medical supplies include pharmaceuticals, othermedications, or other supplies provided for care or service of a patientat a healthcare facility. The system also includes a central servercomputer system 105, which is communicatively connected with data stores110, a central dispensing unit 115, and the dispensing device 120-a. Insome embodiments, one or more of these components may be removed orsubstituted with other devices.

In one embodiment, the dispensing device 120-a includes one or morepatient-specific bins (PSBs) and one or more item-specific bins (ISBs).PSBs are assigned to a patient for exclusive use during a determined, orundetermined, period of time. A PSB may be used for the storage anddistribution of medications and other medical supplies for the assignedpatient. An ISB is a bin which is assigned to an item independent of theitem's relation to a patient (e.g., it may be for use among two or morepatients). A “dispensing device” may be any cabinet or other device fordispensing medications or other medical supplies to patients in ahealthcare facility. In other embodiments, aspects of the system may beused in different settings to dispense a range of other items. A“dispensing device” may be stationary, such as a nursing cabinet servinga particular area of a hospital, or may be mobile. The dispensing device120-a may be in wired or wireless communication with the central servercomputer system 105.

A “bin” may be any container, mechanism, location, or zone in adispensing device 120-a or unit therein, including locations in lockingand sensing drawers. A “bin” may, for example, include a set of storagelocations within a drawer or area of a cabinet. Other types of binsinclude dispensers, shelves, racks, and so on. In one embodiment, only asubset of the bins in a given dispensing device may be designated asavailable for PSBs. In another embodiment, the bins available forassignment as PSBs may be variable depending, for example, on theexisting or future assignments of bins to PSBs or ISBs in a givencabinet.

The dispensing device 120-a may be located at a nursing station servinga number of rooms, at an operating room, at an emergency room, at anintensive care unit, or at a number of other locations as evident tothose skilled in the art. The dispensing device 120-a may be mobile aswell. The dispensing device 120-a may include a computer and consoleconfigured to manage the storage and distribution of medical supplies atthe dispensing device, and networked to communicate with the centralserver computer system 105. There may be different levels of securityfor particular bins within the bins of a given dispensing device 120-a.

The dispensing device 120-a may be made up of one or more dispensingmechanisms that are secured within the device 120-a, with the mechanismsconfigured to dispense items from associated bins. Thus, mechanisms maybe used to give access to the bins to only authorized individuals. Adispensing mechanism may be configured with connections to a variety ofbins that each hold items to be dispensed. Such an arrangement may bewell suited for items that need to be secured, such as medications,drugs, and the like. If a user is authorized, such items may bedispensed from the dispensing device 120-a using the mechanism, wherethey may fall into a dispense drawer that may be pulled to access thedispensing items. Depending on the particular configuration, one or morebins of a dispensing mechanism may be assigned as a PSB or ISB.

A dispensing device 120-a may include a dispenser frame withreconfigurable dividers. In this way, a wide variety of bin anddispensing mechanism arrangements may be provided by reconfiguring thedividers and/or the location of the dispensing mechanisms on thedividers. Further, various types of dispensing mechanisms may beaccommodated. As noted above, one or more bins and associated mechanismsmay be assigned as a PSB or ISB.

Various sensing or detecting systems may be used to determine theconfiguration of the dividers and the addresses of the bins anddispensing mechanisms on the dividers so that the dispensing device120-a computer (and central server computer system 105) may associateone or more items with particular bins. For example, when reconfiguringlocations, a sensing mechanism, such as a button, may be pressed on thedispensing mechanism to indicate the new location of the dispensingmechanism.

The patient dispensing device 120-a is communicatively connected(perhaps over a network) with a central server computer system 105. Thecommunication may be wired, wireless, or a combination thereof. Thecentral server computer system 105 may include, for example, one or moreserver computers, personal computers, workstations, web servers, orother suitable computing devices. The central server computer system 105may be configured to communicate with the dispensing device 120-a, andperform and monitor the patient and bin assignments. The central servercomputer system 105 may allocate bins as ISBs or PSBs, and may eitherassign a patient to a bin or set of bins (e.g., making an assignment ofa patient to a bin upon check-in or transfer) or receive patientassignment information (e.g., from the dispensing device 120-acomputer). The central server computer system 105 may identify items tobe stocked, restocked, or removed from a bin and transmit thisinformation, and/or receive identification of items which are or will bestocked, restocked, or removed (e.g., from the dispensing device 120-acomputer).

The central server computer system 105 may also manage at least part ofthe transfer or discharge of a patient, modifying patient binassignments as appropriate. The central server computer system 105 mayidentify the locations (e.g., return to bin, return to pharmacy, returnto patient) for items to be destocked or otherwise removed with patienttransfer or discharge. The central server computer system 105 may alsobe configured to manage the cleanup or other removal of items from PSBsor ISBs independent of any patient transfer or discharge.

The central server computer system 105 may be configured to trackinventory of medical supplies at the central dispensing unit 115 and thedispensing device 120-a. The central server computer system 105 may beconfigured to consolidate and filter data received from the dispensingdevices 120 at one or more healthcare facilities, and produce and/ortransmit audit or action reports based thereon. Using received data, thecentral server computer system 105 may be configured to generaterestocking lists.

When a stocking or restocking list is generated (e.g., by a centralserver computer system 105, or perhaps by the patient dispensing device120-a), the dispensing device 120-a (or other computing device) mayreceive the list. To initially stock a bin or set of bins in thedispensing device 120-a, a sensing mechanism, such as a button, may bepushed to identify the location. The type and quantity of the itemstocked may then be entered into the computer associated with thedispensing device 120-a. By pressing the button, the computer may detectthe bin or set of bins being accessed and the item assigned to thataddress. A count may be verified, the bin or set of bins restocked, andthe quantity entered (and perhaps transmitted to the central servercomputer system 105). In some embodiments, the central server computersystem 105 or the patient dispensing device 120-a computer mayautomatically direct the user to the PSB for the item to be stocked.

To restock, a restock list may be generated. The dispensing device 120-acomputer may be coupled to a network to permit various restockinformation to be downloaded to the computer (e.g., from the centralserver computer system 105). Alternatively, the computer on thedispensing device 120-a may locally generate the list. This informationmay be stored at the computer, or else accessed when needed over thenetwork. Visual indicators, such as lights, LEDs, or the like, on thedispensing locations that are to be restocked may then be actuated toguide the restock user or pharmacist through the restocking process. Thebutton on the dispensing mechanism may be pushed to identify thedispensing mechanism that is being restocked, and the expected quantitymay be displayed on the display screen. A count may be verified, thedispensing mechanism restocked, and the quantity entered (and perhapstransmitted to the central server computer system 105). In someembodiments, the central server computer system 105 or the patientdispensing device 120-a computer may automatically direct the user tothe PSB for the item to be restocked.

In one embodiment, the central server computer system 105 iscommunicatively connected (perhaps over a network) to a set of datastores 110 stored in local or remote memory. The data stores 110 may beone, or more, relational databases or components of relational databases(e.g., tables), object databases or components of object databases,spreadsheets, text files, internal software lists, or any other type ofdata structure suitable for storing data. Thus, it should be appreciatedthat data stores 110 may each be multiple data storages (of the same ordifferent type), or may share a common data storage with other datastores. The central server computer system 105 may query the data stores110 for information to produce any of the output described above. Thedata stores 110 may store information on which bins in each of anynumber of dispensing devices are available to be allocated as PSBs andwhich bins are presently allocated as PSBs or ISBs, and may also listcharacteristics (type, size, location, security, etc.) of each bin. Thedata stores 110 may also store information on the patient assignmentsfor such bins.

The data stores 110 may also store information on which dispensingdevices are associated with a room or area of the healthcare facility.The data stores 110 may store status information on particular assignedPSBs (e.g., identifying whether a dispensing device 120-a is an activecabinet, an interim or otherwise temporary cabinet, or an inactivecabinet).

The data stores 110 may store information regarding particular patients,and the particular medication orders and other supplies currentlyprescribed for the patient. The data stores 110 may store information onthe past, current, or future associations between a patient, his or herpast, active, or future medication orders, and his or her assigned roomand PSBs (e.g., identifying inventory of medical supplies for thepatient at a PSB). In one embodiment, an “active medication order” is amedication order that has a start date/time that occurs in the past anda stop date/time that occurs in the future (or is indefinite in time); a“future medication order” is a medication order that has a startdate/time that occurs in the future and a stop date/time that occurs inthe future (or is indefinite in time); a “discontinued medication order”is a medication order that is neither active nor future and, thus, isinactive and/or has a stop date that occurs in the past. As used herein,the term “medication order” may be an order associated with one, ormore, medications. Thus, a number of medication orders may be analyzedfor a particular patient at a given time at a device 120, or a singlemedication order may be analyzed including a number of medications.Thus, it may be assumed that a reference herein to a “medication order”may be an order associated with a number of medications, or to a numberof orders each associated with one or more medications.

In one embodiment, the central server computer system 105 iscommunicatively connected (perhaps over a network) to one or morecentral dispensing units 115. A central dispensing unit 115 may, forexample, be a pharmacy storage and retrieval system which has a numberof automated aspects. Thus, a central dispensing unit 115 may receivestocking or restocking information from the central server computersystem 105 (or, perhaps from a computer on the patient dispensing device120), and dispense the medications specified in an automated orpartially automated fashion for cart-fills, or for cart-less or otherenvironments. The computer system associated with the central dispensingunit 115 may be independent from the central server computer system, orthere may be various levels of integration. The central dispensing unit115 may be any automated packaging distribution device, controlledsubstance distribution device, automated medication dispensing device,or other device or mechanism that distributes medications or othersupplies to patient dispensing devices 120. Thus, the central dispensingunit 115 may be a centralized medication distributor located in ahealthcare facility pharmacy. In one embodiment, the central dispensingunit 115 may be a local or remote computing device configured toidentify and track the dispensation of medication.

Referring next to FIG. 1B, an example of an alternative system 150 isillustrated for storing and distributing medical supplies from adispensing device which includes PSBs. The system 150 includes adispensing device 120-b for dispensing medical supplies (e.g.,pharmaceuticals or other medications). The dispensing device 120-b ofFIG. 1B may be implemented to include the functions of the patientdispensing device 120-a described with reference to FIG. 1A, and thus inone embodiment may be implemented in the system of FIG. 1A.

The dispensing device 120-b, which may, for example, be configured as acabinet, includes a number of bins 155 for dispensing medical suppliesto patients. One or more of the bins 155, or a subpart of such a bin155, may be allocated for use as a PSB and assigned to a patient. Thedispensing device 120-b also includes a computer 160. The dispensingdevice computer 160 may be configured to complete any of the functions(or any subset thereof) that may be performed by the central servercomputer system 105 of FIG. 1. Therefore, functions described above tobe performed by the central server computer system 105 of FIG. 1 may beperformed, in whole or in part, by a computer 160 local to a dispensingdevice 120-b. In this way, all or part of a system may be configured tooperate in a centralized, or more distributed manner.

By way of example, the dispensing device computer 160 may be configuredto allocate bins as ISBs or PSBs, and may either assign a patient to abin or set of bins 155 or receive patient assignment information. Thedispensing device computer 160 may also manage at least part of thetransfer or discharge of a patient, modifying patient bin assignments asappropriate. The dispensing device computer 160 may also manage anddirect the cleaning or other removal of items from a device 120-bindependently from the transfer or discharge process. The dispensingdevice computer 160 may identify the locations for items to be removed(e.g., return bin, return to pharmacy, return to patient) with patienttransfer, discharge, or other triggering event. The dispensing devicecomputer 160 may be configured to track inventory of medical supplies.The dispensing device computer 160 may transmit information on itsactions to the central server computer system 105.

Similarly, the dispensing device computer 160 may include memory whichmay store any of the information that is stored in the data stores 110of FIG. 1A. The memory of the dispensing device computer 160 may includeinformation limited to the associated dispensing device 120-b, or it mayinclude information on other patient dispensing devices (e.g., coveringan area making up a subset of an entire facility).

The system 150 may also include a central dispensing unit 115communicatively connected to the patient dispensing device 120-b,perhaps over a network. The central dispensing unit 115 could receivestocking or restocking information from the patient dispensing device120-b, and dispense the medications specified in an automated orpartially automated fashion for cart-fills, or for cart-less or otherenvironments.

Turning next to FIG. 2, a block diagram shows a system 200 for storingand distributing medications and other supplies from dispensing deviceswhich include PSBs. The system 200 of FIG. 2 illustrates one embodimentof the system 100 described with reference to FIG. 1A. The system 200 ofFIG. 2 includes a number of patient dispensing devices 220, including anintensive care device (“ICU”) dispensing device 220-a, an operating room(“OR”) dispensing device 220-b, and a number of nursing unit cabinetdispensing devices 220-c to 220-n (which may be referred to hereinafteras nursing unit cabinets). These may also be mobile dispensing devices,such as carts (not shown). PSBs in a mobile dispensing device may serveto store and deliver medications to the PSBs for the patient at astationary device (e.g., via a cart-fill or during a patient transfer).These patient dispensing devices 220 may be generally configured asdescribed for the dispensing devices 120 of FIG. 1A or 1B. Dispensingdevices 220 may include only PSBs, only ISBs, or a combination of PSBsand ISBs. Also, a dispensing device 220 may be made up of a number ofdistinct physical cabinets logically linked together in a room, area, orhealthcare facility.

The system 200 of FIG. 2 also includes a central server computer system105, which is communicatively connected to each of the dispensingdevices 220. The central server computer system 105 of FIG. 2 mayperform any of the functions described with reference to FIG. 1A, foreach of the dispensing devices 220. The system 200 of FIG. 2 alsoincludes a central dispensing unit 115, which in this embodiment islocated in the healthcare facility pharmacy and is communicativelyconnected to the central server computer system 105. The centraldispensing unit 115 includes an automated storage and retrieval device215-a and an additional pharmacy dispensing unit 215-b.

The central server computer system 105 may generate audit reports withinformation received from one or more of the dispensing devices 220, andmay also generate stocking or restocking lists to be transmitted to andfilled at the central dispensing unit 115. The central server computersystem 105 may use the received information to efficiently allocatestocking and restocking across different carts (which may each serve oneor more dispensing devices 220, and run at different intervals). Theaudit functions and list generation may also be performed by thecomputer associated with a particular dispensing device 220.

In this embodiment, the central server computer system 105 iscommunicatively connected (perhaps over a network) to data stores 110stored in local or remote memory. The data stores 110 may include arooms table 210-a, which identifies rooms (or other areas) in thehealthcare facility, and identifies the dispensing device or devices 220associated with each room (or associated with an area in which the roomis located). Typically, a dispensing device 220 may be associated with anumber of rooms, which may be illustrated in the rooms table 210-a.There may also be a primary association and one or more secondaryassociations. The rooms table 210-a may also include a listing of thepatient associated with the room, and may indicate any PSBs associatedor assigned to the room and/or patient.

The data stores 110 may also include a bins table 210-b, which includesa listing of which bins may be allocated for patient assignment. Thebins table 210-b may, thus, include information on which bins in each ofany number of dispensing devices 220 are available to be allocated asPSBs and which bins are presently allocated as PSBs or ISBs, and mayalso list characteristics (type, size, location, control level,security, etc.) of each bin. The bins table 210-b may also storeinformation on the particular patients assigned to each such bin (e.g.,listing the patient assigned to the bin as well as any other bins towhich the patient is assigned).

In one embodiment, when a bin at a dispensing device is allocated foruse as a PSB, it may also be associated with an item group. There may bea range of different item groups for each healthcare facility. Each itemgroup may be defined as including a set of items of a certain class(e.g., respiratory, refrigerated, ambulance, etc.). Information aboutthe item group or groups associated with a PSB may be stored in the binstable 210-b, as well. Only items belonging to the matching group(s) willbe allowed to be stored in the PSB. A number of different item groupsmay be defined (e.g., in another table in data stores 110 associatingeach group with a one or more different items). One item group may be adefault or “general” group, including all items not associated withother groups. Each item at a healthcare facility may be associated witha group.

In one embodiment, a user will be granted access to a set of one or moreitem groups. When a user attempts to access a PSB, group access will beenforced in addition to control level access. For some item groups,there may be no user access restrictions. A dispensing device 120 orcentral server computer system 105 may enforce the PSB group designationrules such that all PSBs in the same physical access area have the samegroup designation.

Therefore, the bins table 210-b may associate a bin with differentstorage and access restrictions. A first type of storage and accessrestriction may be related to Drug Enforcement Agency drugclassifications, limiting the type (control level) of medications thatmay be stored in certain bins, and limiting access to those bins to onlycertain users. A second type of storage and access restriction may berelated to the item group associated with the bin. The healthcarefacility or other entity may establish rules limiting the type ofmedications that may be stored in bins associated with each item group,and limiting access to those bins to certain users (e.g., only thoseusers granted access to bins of those groups). For a PSB associated witheach type of storage and access restriction, a user would have to havecontrol level and item group access to be granted access.

The data stores 110 may also include an items table 210-c. The itemstable 210-c may be configured to store information and track which itemsare assigned to which bins. The items table 210-c may includeinformation on the inventory level, the control level, the item group,and on whether the item is under an active or future medication order.The items table 210-c may include information regarding whether the binis a PSB or an ISB, and on whether the bin is assigned to a patient (andperhaps identify the assigned patient).

The data stores 110 may store consolidated information on the currentassociations between a patient, his or her past, active, or futuremedication orders, and his or her past, present, or future assignedroom(s) and PSBs. It is also worth noting that the data stores 110 maystore status information on particular assigned PSBs (e.g., identifyingwhether a dispensing device 120-a is an active cabinet, an interim orotherwise temporary cabinet, or an inactive cabinet). The data stores110 may also store information identifying each user's item group accessprivileges and control level access privileges.

In one embodiment, the central server computer system 105 iscommunicatively connected via a network 240 to a distributor/supplier230. The central server computer system 105 (or a particular dispensingunit 220) may access the data stores 110 and the central dispensing unit115 to determine inventory levels and active and future orders forcertain supplies, and communicate order levels to thedistributor/supplier 230 so that certain inventory levels aremaintained. One or more user terminals 235 may program or administer thesystem, and order or request audit or restocking reports.

One example of a patient dispensing device 120 is illustrated in FIG. 3.The patient dispensing device in this embodiment is a cabinet 310, whichmay be constructed from a cabinet frame 312 with various transparentpanels 314. Cabinet 310 further includes a pair of doors 316 and 318that enclose a series of shelves 320 within the cabinet 310. Theseenclosed areas may be temperature-controlled or refrigerated in variousembodiments. Shelves 320 may be divided into various storage locationsusing adjustable dividers 322. Further, associated with each storagelocation may be an item button 324 that may be pressed to record theremoval of items from or placement of items into each storage location.A light 326 may also be positioned adjacent each item button to guidethe user to a specific storage location. Further, a label 328 may beassociated with each storage location and may include information on theitems stored in a particular storage location. Optionally, doors 316 and318 may be locked and only opened when appropriate identificationinformation has been entered into a computer 330. Hence, to remove anitem from one of the shelves 320, a user (e.g., a nurse user or othercaregiver user) may enter appropriate identification information intocomputer 330. In other embodiments, the storage locations or zones couldvary in size, configuration, and security. The locations may beallocated for assignment to patients as PSBs, and the locationsavailable may be adjusted depending on current and projected use levelsand occupancy factors. PSB allocation and patient bin assignment may bemade by the computer 330, or received from a remote location (e.g.,central server computer system 105 of FIG. 1A).

To facilitate the entry of information, the computer 330 may include atraditional keyboard 332 and a key pad 333 containing numeric keys. Atouch pad 333 a may be disposed above key pad 333 and used to control apointer on a display screen 334. Disposed below key pad 333 are keys tocontrol the contrast of display screen 334 and to control the sound thatmay be emitted from a speaker 333 b. Disposed below keyboard 332 is areceipt port 333 c through which printed receipts or labels may pass.The panel containing keyboard 332 may be rotated downward to gain accessto the receipt printer. The illustrated computer configuration is forpurposes of example only; in other embodiments, any subset of thefeatures may be employed, and particular implementations and inputdevices may vary.

One use of the various input devices on the computer 330 is to permitthe user to select one or more items that are to be removed. A list ofitems, generated by the computer 330 or received from the central servercomputer system 105, may be displayed on the display screen 334.Further, display screen 334 may be a touch screen display that permitsvarious items to be selected simply by touching them on a display screen334. Computer 330 may be coupled to any type of computer network topermit various information to be supplied to computer 330 (e.g., by thecentral server computer system 105 of FIG. 1A). For example, stock orrestock lists may be transmitted from the central server computer system105, as may lists for cleaning or other removal of items.

When the appropriate items have been selected, doors 316 and 318 may beunlocked (in cases where doors 316 and 318 are already locked) and theappropriate lights 326 may be lighted to guide the user to the itemsselected. Upon removal of the items, the user may press item buttons 324a number of times corresponding to the number of items removed. Asimilar process may be used for restocking items into the storagelocations.

A cabinet 310 may further include a pharmacy section 336 with variousdrawers 338 for holding pharmaceutical items or other types of itemsthat need additional security. When appropriate information has beenentered into computer 330, the appropriate drawers 338 may be unlockedand lights 340 on the drawers lighted to guide the user to theappropriate doors. Drawers 338 may conveniently include various bins(e.g., allocated as PSBs or ISBs) which may optionally have lockablelids to provide additional security to the items. The lids correspondingto bins that have the selected items may be unlocked and users may beguided to the unlocked bins using lights in a manner similar to thatdescribed with shelves 320.

In one embodiment, pharmacy section 336 further includes a dispensingunit area 342. Briefly, dispensing unit area 342 includes a dispensingunit frame that is insertable into cabinet frame 312 of cabinet 310.Coupled to the dispensing unit frame is a door 346 that may be opened toprovide access to dispenser frame. Although dispensing mechanisms maytypically be associated with items for use by a number of patients,particular bins associated with dispensing mechanisms may be assigned topatients in some embodiments. Below dispenser frame is a dispense drawer352 that receives items that fall from dispensing mechanisms after suchitems have been selected at computer 330. Bins within the dispensedrawer 352 may be assigned as PSBs on a temporary or more permanentbasis to specific patients. The dispense drawer 352 may include a light354 to guide the user to the dispense drawer 352 during dispensingoperations. A handle 356 may be provided on door 346 to facilitateopening of door 346. The door 346 may include a light 357 to guide theuser to the door 346 during dispensing operations.

In some cases, dispensed items may need to be returned to cabinet 310.In some situations, various laws, regulations, or facility policiesprohibit dispensed items from being placed back into cabinet 310. Assuch, attached to (or otherwise integrated into) cabinet 310 may be areturn unit 358 having a slidable (or rotatable) door 360 that may beopened to permit the item to be placed into the return unit 358. Whenreturning the item, information regarding the return may be entered intocomputer 330. A light 362 on the return unit 358 may be lighted toindicate to the user that the item may be returned. The return unit 358is preferably configured so that once an item is placed into the unit,the item cannot be retrieved from the return unit 358 unless a restockuser or technician is authorized to gain access. For example, a restocktechnician may be required to enter appropriate information intocomputer 330 to cause the return unit 358 to unlock to allow access tothe items within.

Although one specific arrangement of cabinet 310 has been described, itwill be appreciated that any subset or combination of the above PSBcomponents may be used with a variety of dispensing cabinets. Forexample, a dispensing mechanism and unit may be placed within a cabinetthat is used solely for dispensing pharmaceuticals and may only includedrawers similar to drawers 338. As another alternative, such mechanismsand units may be placed in a cabinet that only includes shelves that aresimilar to shelves 320. Further, such mechanisms and units may be usedin cabinets having multiple shelves and/or drawers that are placedside-by-side in a vertical arrangement. Also, a dispensing cabinet mayinclude multiple dispensing unit areas 342. These may be sized to thesame size, or may be different sizes. Still further, in some cases suchdispensing cabinets may include other types of shelves, racks, drawers,and the like to facilitate the storage of items.

Referring next to FIG. 4, an illustration of one embodiment of a drawer338 from FIG. 3 is shown. The allocations and patient assignmentsdescribed with reference to the drawer 338 may be employed in otherembodiments. In one embodiment, the drawer 338 includes a number of bins405. There are a first subset 415 of the bins 405 that may be allocatedto be assigned to patients, and a second subset 410 that may beallocated for assignment to items. In one embodiment, the computer 330(or perhaps the central server computer system 105) may vary theallocations according to current and/or projected future inventory anduse levels. In other embodiments, a drawer may be configured of onlyPSBs.

There are a number of different configurations of other types ofdispensing devices 120, and FIG. 5 illustrates yet another example ofsuch a device. The illustrated dispensing device 510 may include one orall of the functions of the patient dispensing devices 120 describedwith reference to the system 100 of FIG. 1A or the system 150 of FIG.1B, and thus may be implemented in either system. Thus, the device 510may be in wired or wireless communication with the central servercomputer system 105.

The dispensing device 510 includes a cabinet 512 having a number ofretractable drawers 514. Although shown with 12 drawers, the number ofdrawers may be varied. The cabinet 512 may rest upon wheels 516, whichallow the dispensing device 510 to be wheeled throughout the healthcarefacility. The cabinet may be battery powered and configured tocommunicate wirelessly (e.g., to allow communication while in transit).The cabinet 512 may be fashioned with various dimensions.

The dispensing device 510 further includes an integrated computer(hidden within cabinet 512) and a keyboard 518 for entering variousinformation into the computer. For example, keyboard 518 may be employedto enter patient identification information, user identificationinformation, requests for item stocking and removal, and the like intothe computer. Optionally, the dispensing device 510 may further includea second entry device 520 which is connected to the computer andincludes a screen 522 which allows the user to scroll through variouslists of information in order to select a highlighted item. For example,a caregiver may scroll through a list of patient names or item names inorder to select a certain patient or to enter an item removal orstocking request. In one embodiment, the screen may be a color touchscreen. The touch screen may be configured to allow a user to interactwith the dispensing cabinet, with or without having to use the keyboard,mouse, or other traditional methods, as the touch screen functionalityallows a user to touch their selection directly. The touch screen may bea color touch screen, and color distinctions may inform and guide theuser (e.g., alerts or warnings in yellow, item unavailability in grey,next steps in green).

A printer 524 may be provided on cabinet 512 to print various reports orlabels generated by the computer. In other embodiments, some of thecomputing functionality for a device 510 (e.g., display, input device,reader, etc.) may be detachable or otherwise separate from the device510, and may communicate wirelessly with the device 510 or centralserver computer system 105.

The cabinet 512 may further include a magnetic, bar code, RFID, datacollector or other reader 525 which is connected (directly orwirelessly) to the computer. Such a reader 525 may be employed on any ofthe dispensing devices 120 described herein. It may be configured tomanually or automatically scan for types and associated quantities orlevels then provide the data to the cabinet 512 or to the centralcomputer system 105. The reader 525 may be provided to allow a user, apatient, or particular medications or other supplies to be identified.For example, an identifier (e.g., magnetic, bar code, RFID, or otheridentifier) may be read from a medication container when an item isstocked, restocked, or removed. The identifier (and amount) may then betransmitted to the central server computer system 105 or otherwisestored, for purposes of tracking inventory. Similarly, an identifier(e.g., magnetic, bar code, RFID, or other identifier from an access cardor other instrument) may be read from the user of the device or patientassociated with the device. The reader 525 may also be employed to readan identification device associated with the drawers, as well.

To retrieve or remove items of a particular patient, a user (e.g., anurse user or other caregiver, patient, automated system, etc.) mayenter user identification (e.g., a password, PIN, smart card, RFID,combination thereof, etc.) using keyboard 518, reader 525, or entrydevice 520. The user (or the computer 330) may then identify thepatient. The patient identification may be entered by the user usingkeyboard 518, reader 525, or entry device 520. The user may select thedesired medication or other supplies, or the computer (or a centralserver computer system 105) may direct the user (via lights or alisting, for example). The user may also enter the number of items ofthe selected type that are to be removed or retrieved for the patient.The user may then retract the proper drawer and will be led to thecorrect bin. There may also be a step of verifying the count of specificitems taken, by prompting the user to enter via keyboard 518 or entrydevice 520 the number of items of the specific type that were removed orsupplied and the number remaining. A record of this event may also bemaintained within the computer, or may be transmitted to the centralserver computer system 105 of FIG. 1A or 1B, or elsewhere. A variety ofother removal alternatives may be used, as well.

For stocking and restocking of items into dispensing device 510, thepharmacy or other central dispensing unit (e.g., central dispensing unit115 of FIG. 1A or 1B) may prepare all items for a particular cart fillat a particular PSB or set of PSBs together in a set of packages orother container. For example, all of the medications for a given PSB maybe gathered and consolidated at the pharmacy or other central dispensingunit before they are placed in the cart. The computer for the cabinet510, or perhaps the central server computer system 105 of FIG. 1A or 1B,may transmit the restock list to the pharmacy, or a list may beprocessed locally at the pharmacy. The process of gathering andconsolidating the supplies for a particular PSB may therefore take placeat the pharmacy or other central dispensing unit, instead of at thedispensing device 510. This may provide a more secure environment, andresult in less loss. It may also be more efficient for a pharmacistinstead of a nurse user to perform these tasks.

To stock or restock a PSB, the user may enter user, patient, and/orpackages/container identification (e.g., a password, PIN, label, serialnumber, bar code, identification device, smart card, RFID, etc.) usingkeyboard 518, reader 525, or entry device 520. Thus, the entry of user,patient, or packages/container identification information (or anycombination thereof) may trigger the restocking process. The computerfor the cabinet 510 (perhaps controlled by the central server computersystem 105 of FIG. 1A or 1B), may direct the user (e.g., via lights orscreen information) to place the packages/container in the appropriatePSB. The action may be logged, and perhaps transmitted to the centralserver computer system 105.

In other embodiments, instead of having the pharmacy or other dispensingentity consolidate the restocking items, individual items may be placedin a PSB or ISB on an item-by-item basis at the dispensing device 510.For example, the pharmacy or other central dispensing unit (e.g.,central dispensing unit 115 of FIG. 1A or 1B), or central servercomputer system 105 of FIG. 1A or 1B, may be in frequent contact withdispensing devices. Information may be exchanged with the dispensingdevices, and in particular information on the current quantity on handfor each item in each dispensing device. At regular intervals (e.g.,every morning) a restock list may be generated for each dispensingdevice, detailing the total quantity of each item to be taken to thedispensing devices to bring the quantity in each receptacle (e.g., PSBor ISB) up to a predetermined (or dynamically calculated) par level.

As another alternative, a pre-stocked liner for one or more bins may beprepared at the pharmacy, central dispensing unit, or elsewhere. Thereplacement liner may be configured to have the same arrangement of binsand items or a different arrangement of bins and items. A variety ofother restocking systems may be used, as well. Although the retrievaland stocking are described with reference to the cabinet 510 of FIG. 5,these procedures may be applied to other dispensing devices (e.g., thedispensing device 120 of FIG. 1A or 1B), as well. The stocking orrestocking may be performed when a patient first checks into a hospital,when there is a need for refills, or in managing a transfer, to name afew instances.

Referring now to FIG. 6, an example of one of the drawers 514 from FIG.5 will be described in greater detail. This drawer embodiment may beemployed in a number of alternative dispensing devices, as well.Moreover, in other embodiments, a variety of different drawerconfigurations may be utilized, and this configuration is for purposesof example only. Drawer 514 of FIG. 6 includes a frame 626 having ahandle 628 and a track 630 which allows the tray to be slid in and outof cabinet 512. A visual indicator 632, such as an LED, is provided onthe drawer 514 to allow a specific drawer to be identified upon enteringor otherwise receiving an item removal or stocking request. The drawer514 may be configured to receive a removable liner 634 which holds theitems to be dispensed. Liner 634 is divided into a number of bins 636(which may be allocated or assigned as PSBs or ISBs, as describedabove). The bins in this embodiment include adjustable transversedividers 638 and longitudinal dividers 657. Attached to at least some ofthe dividers are light pipes 640 which are employed to guide a user to aspecific bin. Liner 634 is configured to rest within the frame 626 andmay be removed by simply lifting the liner from drawer 514 by handles642.

Referring now to FIG. 7, an example of one of the liners 634 from FIG. 6will be described in greater detail. In other embodiments, a variety ofother liner configurations may be utilized, and this configuration isfor purposes of example only. Within the liner, there are a number ofapertures 768 for receiving light pipes 640. Apertures 768 are largeenough to allow light pipes 640 to pass through liner 634. Apertures 768are in a two-dimensional array so that an aperture 768 will be presentfor each light pipe 640 in a number of divider 638 configurations. Inone embodiment, two light pipes 640 attached to separate dividers 638(perhaps opposite each other) will be associated with each bin. Inanother embodiment, a single light pipe may uniquely identify each bin.

Referring next to FIG. 8, one embodiment of a method 800 of associatingmedications with bins in a dispensing device is described. This method800 may, for example, be performed in whole or in part by the centralserver computer system 105 of FIG. 1A or 2. Alternatively, the method800 may, for example, be performed in whole or in part by a computerassociated with a dispensing device 120 or 220 of FIG. 1, 1B, or 2.

At block 805, one or more bins at a dispensing device associated with apatient are allocated for PSB use and/or assigned to a patient for useas PSBs. At block 810, one or more different bins at the dispensingdevice are allocated for use as ISBs to be assigned to hold one or moreunits of a particular item for use by a number of patients. At block815, one or more medication orders for the patient are analyzed toidentify a first set of medications from the medication order(s) asmedications stored in the ISBs. At block 820, the medication order(s)are analyzed to identify a second set of medications from the medicationorder(s) as medications to be stored for the patient in PSBs. Themedication order(s) may be compared to a listing of items stored in theitem-specific bins to identify the second set of medications. At block825, a subset of the second set of medications is associated with aselected one of the PSBs. The selected PSB may be identifiedautomatically, or may be selected by a user.

The medication order information for the patient may be received fromother devices in the system. In one embodiment, the medication orderinformation may be used to determine automatically which items to placein the selected PSB for the patient. The identifying data may then betransmitted (e.g., to the dispensing device 120 or central dispensingunit 115 of FIG. 1). The inventory at the selected PSB may be tracked bymonitoring stocking and removal (e.g., when a central server computersystem 105 receives stocking and removal information transmitted from adispensing device 120). Items to be restocked in the selected PSB may beidentified, based in part on the received medication order informationand the tracked inventory.

The foregoing discussion provides a generalized description of a rangeof novel aspects of a system including PSBs. In turning to specificembodiments, additional novel aspects will now be discussed in SectionsI-XIII. Although the system 100 of FIG. 1 is directly or indirectlyreferenced in the following description of certain embodiments of theinvention, it must be emphasized that all illustrated components neednot be used. Similarly, components not illustrated in the system 100 ofFIG. 1 may be used in certain embodiments. For example, similarcomponents (e.g., the central server computer system 105) of the system200 in FIG. 2 may be used. Therefore, it should be recognized that anydescription related to FIG. 1 is for purposes of example only. Moreover,although many of the functions may be described as being performed bythe central server computer system 105, the functions described (or anysubset thereof) may be performed by the computer of patient dispensingdevice 120 of FIG. 1A or 1B or dispensing device 220 of FIG. 2.

In the following discussion, the items to be dispensed are oftendescribed as medications. However, this is for purposes of example only,as the principles set forth may be applied to the storage of othermedical supplies, as well. In a number of embodiments described below,the system 100 includes a patient dispensing device 120-a (e.g., anursing unit cabinet), with a subset of bins allocated for assignment toa patient as PSBs. While it may not be noted in each instance, there mayalso be ISBs available for assignment to a particular type of item to beused by a number of patients. In this Application, the term “PSB” isused interchangeably with the term “patient-specific bin,” and the term“ISB” is used interchangeably with the term “item-specific bin.”

I. Status Designation for Dispensing Device: In one set of embodiments,a patient may be associated with dispensing devices at two differentphysical locations at the same time. Referring initially back to thesystem 100 of FIG. 1, the system 100 may be configured to address theinstances when a patient's physical location is mobile or transitorywithin a healthcare facility. Each dispensing device 120 may have adifferent designated status defining the services to be provided at therespective device. A system 100 may, therefore, be configured to beflexible to address patient needs at different locations, and ininstances when a location (e.g., a room or area) associated with apatient is a future, past, temporary, or mobile location. Statusdesignation may also address circumstances when the patient's actuallocation is uncertain or unknown.

Therefore, in one embodiment, a central server computer system 105 ofFIG. 1A associates a different status to two or more dispensing devices120 associated with a patient. In doing so, when a PSB in the dispensingdevice is assigned to the patient, the status designation of thedispensing device 120 may define the status of the PSB, as well. Thus,status designations may be attributed to a particular dispensing device120 or a PSB. A status designation may indicate which services are to beprovided to a patient at a given location.

Turning to FIG. 10, an example of a system 1000 is illustrated fordesignating the status of a dispensing device which includespatient-specific bins. The illustrated system 1000 includes twodispensing devices, dispensing device-a 1010-a and dispensing device-b1010-b. Each device may, for example, be a dispensing device 120 or 220of FIG. 1A, 1B, or 2, and thus may be a cabinet with a number of binsfor dispensing medical supplies (e.g., pharmaceuticals, othermedications, or other supplies for a patient at a healthcare facility).The system 1000 also includes a central server computer system 1005,which is communicatively connected with each dispensing device 1010. Thecentral server computer system 1005 may be the central server computersystem 105 of FIG. 1A, 1B, or 2. The system may include any other numberof connected dispensing devices (not shown), and thus the illustratedembodiment is for purposes of example only.

Dispensing device-a 1010-a may be associated with location-a 1015-a.This association may indicate that dispensing device-a 1010-a is acabinet at a nursing station serving a set of rooms which includelocation-a 1015-a. The patient may be physically located within one ofthe rooms of location-a 1015-a, and the central server computer system1005 may reflect this association. However, in some embodiments,location-a 1015-a may be a past or future location for the patient, orbe another type of room or location (e.g., an operating room, emergencyroom, a transitory location between two rooms, etc.).

Dispensing device-b 1010-b may be associated with location-b 1015-b.This association may also indicate that dispensing device-b 1010-b is acabinet at a nursing station serving a set of rooms which includelocation-b 1015-b. The patient may again be associated with location-b1015-b, as the location-b 1015-b may be a past, present, or futurelocation of the patient, either in fact or as represented by the centralserver computer system 1005.

Therefore, because a patient may be associated with dispensing devices1010 at two different locations 1015-a and 1015-b, the patientmedication and other supply needs may be served from each location.However, in one embodiment, there is a different status associated witheach dispensing device 1010-a and 1010-b, the status providing anindication of the services which are allowed (or are required) to beprovided at each device 1010 (and thereby at one or more PSBs therein).The different status designations may concurrently be in effect. Eachstatus designator may, therefore, provide different limitations and/orrequirements on the services that may be provided at each location at agiven time (e.g., user behavior may be restricted based on a firststatus designation at one device 1010-a, but not at another device witha different designation 1010-b).

The central server computer system 1005 (or, perhaps, a computer foreach device 1010) may designate, change and store the status associatedwith each device 1010. The status designations may be mutuallyexclusive, or the system may be configured to share designations amongdifferent devices.

There may be any number of status designations available for a givensystem 1000. The following designations are possible, but are only forpurposes of example, as those skilled in the art will recognize therange of possibilities:

-   -   Active: designated to a dispensing device 1010 associated with        the patient's room in the rooms table, although not necessarily        where the patient is physically located;    -   Interim: designated to a dispensing device 1010 associated with        the room where the patient was located before a new cabinet was        designated as the active cabinet. The interim cabinet may, but        need not necessarily be, where the patient is physically        located;    -   Inactive: designated to a dispensing device 1010 after        confirmation is received that a patient has physically moved        from a previously active device 1010 and/or his medication and        other supplies at the device have been physically removed;    -   Temporary: designated to a dispensing device 1010 in a room or        location that the patient will occupy only temporarily (e.g., 4        hours or less, 6 hours or less, etc.). An operating room or        other temporary procedure area (e.g., an x-ray or therapy room)        might have this designation;    -   Transitory: designated to a dispensing device 1010 associated        with a patient who is being moved (e.g., between healthcare        facilities, or within a healthcare facility); or    -   Delivery: designated to a mobile dispensing device 1010 used for        delivering medications and associated with the patient.

For each status designation, a different set of services may be allowed,prohibited, required, etc. For example, a status may require thatcertain services be provided, and/or may limit the services that areprovided to certain users. The set of services that are associated witha given status may be set, or they may be programmed or modified by anadministrator. Certain users may be given the ability to override theset of services mandated or allowed at a device of a given status.

In one embodiment, all or any subset of the following functions may belimited or mandated at a device 120 or PSB based on a given statusdesignation: item removal, item return, return location, item destock,PSB control level, PSB attribute modification, restock and/or restocksupply level, supplemental restock and supplemental restock supplylevel, item assign or un-assign, patient bin assign or un-assign, PSBdesignation or reallocation, transfer patient medications, receivepatient medications, expiration tracking, item bar code confirmation,quantity verification, witness requirements and/or receive or removepatient's own medications. By way of example, a status designation at alocation may dictate where a restock list is to be sent, which items areto be restocked at respective locations, what quantities (days' supply)are to be restocked, when a cabinet should be cleaned, which items areto be removed, where removed items should be placed, whether a patientis being transferred or discharged, which patient care services may beprovided at the location, and so on.

The status designations may be entered by a user, or may be entered ormodified automatically (e.g., the central server computer system 1005 orcomputer for the device 1010). For example, consider an example of apatient moving 1020 from location-a 1015-a to location-b 1015-b. Thestatus designation of a first device 1010-a may be changed automaticallyupon receiving information confirming the patient has physically arrivedat location-b 1015-b. The status designation of the first device 1010-amay be changed automatically upon receiving information confirming thepatient has physically departed from location-a 1015-a, or that thepatient's physical location has otherwise changed. Thus, a statusdesignation change may be automatically triggered by a confirmation of aphysical location change (departure, arrival, other change). The changedstatus designation may trigger removal of items stored in a PSB for thepatient at dispensing device-a 1010-a (e.g., triggering immediateremoval, or simply when a user next uses the device 1010-a).

Referring next to FIG. 11, an example of a system 1100 is illustratedfor designating the status of dispensing devices which include PSBs. Theillustrated system 1100 includes three such dispensing devices,dispensing device-a 1110-a, dispensing device-b 1110-b, and dispensingdevice-c 1110-c. Each device may, for example, be a dispensing device120 or 220 of FIG. 1A, 1B, or 2, and thus may be a cabinet with a numberof bins for dispensing medical supplies (e.g., pharmaceuticals, othermedications, or other supplies for a patient at a healthcare facility).The system 1100 also includes a central server computer system 1105,which is communicatively connected with each dispensing device 1110. Thecentral server computer system 1105 may be the central server computersystem 105 of FIG. 1A, 1B, or 2. The central server computer system 1105may include any other number of communicatively connected dispensingdevices (not shown), and thus the illustrated embodiment is for purposesof example only.

Dispensing device-a 1110-a is associated with room 1 1115-a (e.g., inthe rooms table 210-a of FIG. 2). This association may indicate thatdispensing device-a 1110-a is a cabinet at a nursing station serving aset of rooms which include room 1 1115-a. In this example, the patientis initially physically located within room 1 1115-a, and the centralserver computer system 1105 reflects this association. In the currentexample, dispensing device-a 1110-a is designated with an active status,indicating that the dispensing device provides full functionality to thepatient.

Dispensing device-b 1110-b is associated with an operating room 1115-b(e.g., in the rooms table 210-a of FIG. 2). This association mayindicate that dispensing device-b 1110-b is a cabinet at the operatingroom 1115-b or a nursing station serving the operating room 1115-b. Whenthe patient is moved 1125 to have a procedure performed in the operatingroom 1115-b, the central server computer system 1105 may reflect thisassociation (e.g., for a future operation, or when the operation isoccurring). Dispensing device-b 1110-b may be designated with atemporary status, indicating that the dispensing device providesfunctionality to the patient (e.g., restocking) for only the scheduledoperating time plus a margin. This may mean that the amount ofrestocking is limited, and/or that certain types of restocking listsshould be routed only to the active dispensing device 1110-a. Otherlimitations or requirements may be associated with the temporary status,as well. Once it has been confirmed that the patient has physically left1130 the operating room 1115-b or returned 1130 to room 1 1115-a afteran operation, dispensing device-b 1110-b could be designated with aninactive status, triggering the cleaning of dispensing device-b 1110-b.

Dispensing device-c 1110-c is associated with room 2 1115-c (e.g., in arooms table 210-a of FIG. 2). This association may indicate thatdispensing device-c 1110-c is a cabinet at a nursing station serving aset of rooms which include room 2 1115-c. The central server computersystem 1105 may receive information that the patient is to betransferred 1135 to room 2 1115-c, and may reflect this association.Dispensing device-c 1110-c is designated with an active status,indicating that the dispensing device provides full functionality to thepatient. There may not yet be confirmation that the patient has vacatedroom 1 1110-a. An interim status may, therefore, be designated todispensing device-a 1110-a (i.e., the room where the patient was locatedbefore a transfer). Note that stocked items at the interim PSB may nothave been transferred, and the patient may not yet have been physicallytransferred. A dispensing device with interim status may provide somesubset of the functionality provided by the device with active status.After receiving confirmation that the patient and/or his medication andother supplies at dispensing device-a 1010-a have been physicallytransferred (e.g., a confirmation received by the central servercomputer system 105), dispensing device-a 1010-a may be designated withinactive status for the patient.

Referring next to FIG. 12, one embodiment of a method 1200 ofdesignating status to dispensing devices is illustrated. This method1200 may, for example, be performed in whole or in part by the centralserver computer system 105 of FIG. 1A or 2. Alternatively, the method1200 may, for example, be performed in whole or in part by a computerassociated with a dispensing device 120 or 220 of FIG. 1A, 1B, or 2. Inthis embodiment, the dispensing device 120 is a cabinet.

At block 1205, a first dispensing device serving a first locationassociated with a patient is identified. This may, for example, be acabinet serving an area which includes a room that is currently assignedto the patient. Alternatively, this may be a cabinet serving an areawhich includes a room that was previously assigned to a patient, whenthe system lacks confirmation that the patient has left the room. Thismay also be a mobile cabinet serving a patient in transit (e.g., withinor outside a healthcare facility), a temporary cabinet (e.g., assignedduring a procedure), or a cabinet that will be assigned in the future.At block 1210, a first status is designated to the first dispensingdevice, the first status identifying a first set of services which areallowed for the patient at the device.

At block 1215, a second dispensing device serving a second locationassociated with a patient is identified. This may, for example, be acabinet serving an area which includes a room that is currently or waspreviously assigned to the patient, or be a mobile, temporary, or futurecabinet. At block 1220, a second status is designated to the seconddispensing device, the second status identifying a second set ofservices which are allowed for the patient at the device. At least asubset of the second set of services is not among the first set ofservices. In one embodiment, therefore, different status designationsmay specify the different services allowed for a device.

Referring next to FIG. 13, an alternative embodiment of a method 1300 ofdesignating status to dispensing devices is illustrated. This method1300 may, for example, be performed in whole or in part by the centralserver computer system 105, the computer associated with a dispensingdevice 120 or 220, or any combination thereof. Each step may beperformed automatically (without user or operator action orinvolvement), or may in whole or in part be initiated and/or performedby a user providing input to the applicable computing device. In thisembodiment, the dispensing device 120 is a cabinet.

At block 1305, a first dispensing device is identified as serving a roomassigned to a patient. At block 1310, a PSB in the first dispensingdevice is assigned to the patient. At block 1315, a first status isdesignated to the first dispensing device, the first status identifyinga set of services which are allowed for the PSB at the device. Theallowed services may be identified indirectly (for example, via alisting of allowed services stored at the central server computer system105, the listing corresponding to the status).

At block 1320, a second dispensing device is identified as serving asecond location associated with a patient. At block 1325, the firststatus is designated to the second dispensing device, the first statusagain identifying the first set of services which are allowed for thepatient at the device. At block 1330, the designation of the firstdispensing device is changed to a second status, the change triggered bythe status designation at the second dispensing device. In oneembodiment, at least some of the status designators are mutuallyexclusive; in other embodiments, the status designator may be shared. Atblock 1340, a limited restocking is directed to the first dispensingdevice, the limited restocking based at least in part on the secondstatus. A “limited restocking” may mean that only certain items and/oronly smaller quantities of a given item are restocked at the device.

At block 1345, information is received confirming that the patient'sphysical location has changed (e.g., that the patient has left the firstlocation or that the patient has arrived at the second location. Atblock 1350, the designation of the first dispensing device is changed toa third status, the change triggered by the confirmation information. Atblock 1355, a restock list is routed to the second dispensing devicebased at least in part on the second status designation At block 1360, aclean out directive for the assigned PSB is routed to the firstdispensing device, the clean out directive triggered by the thirddesignation

Referring next to FIG. 14, one embodiment of a method 1400 ofdesignating status to dispensing devices is illustrated. This method1400 may, for example, be performed in whole or in part by the centralserver computer system 105, the computer associated with a dispensingdevice 120 or 220, or any combination thereof. In this embodiment, thedispensing device 120 is a cabinet.

At block 1405, a cabinet associated with a newly assigned patientlocation is identified (e.g., via the rooms table 210-a of FIG. 2). Atblock 1410, the identified cabinet is identified as the “active”cabinet, so it can provide full PSB functionality for the patient. Atblock 1415, the previously “active” cabinet is designated as “interim”so it can continue to provide PSB functionality (either fullfunctionality or perhaps limited to certain items or quantities) untilthe patient physically moves to the new assigned location. Thus, incertain embodiments, the activities that may be performed from theinterim cabinet may be limited due to the “interim” designation.

After the patient physically moves to a new assigned location, at block1420 information is received indicating that the patient has beenphysically moved. At block 1425, the designation of the interim cabinetis changed to “inactive” so that it is no longer available for PSB usefor the patient. This designation may, for example, trigger the cleaningof the inactive cabinet.

II. Identifying Items for Restocking of a Dispensing Device: For anotherset of embodiments, various systems, methods, and devices are describedfor identifying items in a medication order that are to be reordered.The items from one or more medication orders may be compared to theitems in common stock (e.g., in ISBs) at a dispensing device, toidentify items that are to be stored in PSBs for the patient. Of thoseitems to be stored in the PSBs, those that are at or below reorderlevels may be identified for a restock list to be generated for adispensing device 120 or 220 of FIG. 1A, 1B, or 2.

A set of example embodiments will now be described with reference toFIG. 2. It is worth noting, however, that the functions described may beperformed by the central server computer system 105 of FIG. 1A or 2, thecomputer associated with a dispensing device 120 or 220 of FIG. 1A, 1B,or 2, or any combination thereof. A system 200 includes a number ofdispensing devices 220 in communication with a central server computersystem 105 at a healthcare facility. Each dispensing device 220 may beassociated with one or more rooms or areas. A patient is assigned aroom, and thus a nursing unit cabinet 220-c may be associated with theroom assigned to the patient (e.g., via rooms table 210-a). In otherembodiments, a range of other types of dispensing devices 120 or 220 maybe used.

In one embodiment, the nursing unit cabinet 220-c includes one or morePSBs assigned for exclusive use to a patient of a plurality of patients,and one or more ISBs each allocated for an item available to be used bythe plurality of patients. An ISB is a bin which is assigned to an itemindependent of the item's relation to a patient (e.g., it may be for useamong two or more patients). The central server computer system 105 maydynamically allocate the bins for patient- or item-specific use, or theallocation may be static.

In one embodiment, a medication order is generated or received by thecentral server computer system 105. The order may identify a medicationor medications to be administered for or otherwise used by a patient,based on current or future needs (e.g., the medication order may be anactive or future order). While the medication order may be generatedinternally (by the central server computer system 105 or a dispensingdevice 120 computer), it may alternatively be received from an externalsource (e.g., an external source of patient information and medicationorders). The medication order may be compared to a listing ofmedications stored in the one or more ISBs at the nursing cabinet 220-c(e.g., the common stock), to determine those items of the medicationorder to be stored in the one or more PSBs at the cabinet 220-c (e.g.,the items in the medication order not in common stock). There may beitems that are not in common stock at the cabinet 220-c, and yet whichare not to be stored in PSBs (e.g., excluded items). The items to bestored in PSBs may already be stocked for the patient or may be newitems that were not previously stocked.

The central server computer system 105 may identify a reorder level forone or more of the items to be stored in a PSB at the cabinet 220-c, thereorder level triggering reorder of respective items. The central servercomputer system 105 may then determine whether the one or more PSBs forthe patient at the cabinet 220-c are at or below the identified reorderlevels. A central server computer system may receive data from thecabinet 220-c, or elsewhere, identifying current levels of supply forthe items of the medication order to be stocked in PSBs. Thus, thecentral server computer system 105 (or the dispensing device 120computer) may monitor the actual usage and actual quantity on hand inboth PSBs and ISBs to provide updated information. In one embodiment,the data is used in the determination of whether the PSBs for thepatient at the device are at or below the identified reorder levels. Itis worth noting that a particular medication order may be associatedwith one, or more, medications. Thus, a number of medication orders maybe analyzed for a particular patient at a given time at a device 220, ora single medication order may be analyzed including a number ofmedications.

The central server computer system 105 may be further configured toidentify, for items determined to be at or below the identified reorderlevels, a reorder amount for the patient at the dispensing device. Thecentral server computer system 105 may identify a target level at whichto bring the items for the patient in restocking the dispensing device.Thus, the central server computer system 105 may identify a reorderamount for the patient for each item by comparing the target level to acurrent level of supply.

Referring next to FIG. 20, an example diagram 2000 illustrates a reorderlevel 2005 and a target level 2010 for an item to be stored for apatient at a PSB at a dispensing device (e.g., the dispensing device 120of FIG. 1A, or cabinet 220-c of FIG. 2). The following functionalitymay, for example, be undertaken by the central server computer system105. At specified times (e.g., one or two times daily), one or moremedication orders may be analyzed to determined the use requirements ofa patient for an item to be stocked in a PSB at a dispensing device.

Based, for example, on consumption rates and a minimum supply amount(e.g., measured in time), a reorder level 2005 may be identified. Thereorder level may be the supply level triggering reorder. A currentlevel of supply of the item at the PSB may also be identified. If thecurrent quantity of the item in the PSB is at a lower level 2015 thanthe reorder level 2005 when the medication order is processed, a reorderfor the item is triggered. Based, for example, on consumption rates anda desired re-supply amount (e.g., measured in time), a target level 2010may be identified. The target level 2010 may be the supply level towhich to bring the quantity upon restock. The reorder quantity may bethe difference between the current level of supply and the target level2010. If the quantity of the items in the bin(s) is at a higher level2020 than the reorder level 2005 when the medication order is processed,no reorder is triggered. If the medication order changes, and thecurrent supply of items is at a higher level 2025 than the target level2010, the dispensing device 120 may (or may not) be directed to have theitems removed (e.g., during cleaning or at other times), depending onthe amount of overage and estimated remaining use of the items by thepatient (e.g., as set forth in a current or future medication order).Those skilled in the art will recognize the many implementation optionsfor such a system.

The medication order or other consumption information (e.g., based on anestimate using past use rates for the patient or like patients) may beused to determine a rate of use by the patient for each item, and therate of use may be used to identify the reorder level and/or the targetlevel. A central server computer system 105 may, for example, identify areorder days supply and a target days supply for the one or more itemsat the dispensing device 120. The target days supply may be used inconjunction with the consumption information to identify the targetlevel. Similarly, the reorder days supply may be used in conjunctionwith the consumption information to identify the reorder level.Additionally, the reorder level or target level may be modified if therate of use changes, as a modified rate of use would change the numberof days supply (for a given level of supply).

Table 1 illustrates an example of reorder and target levels, based on adays supply calculation. Table 1 is a table for Drug A, with amedication order indicating that Drug A is to be administered threetimes per day (at 9:00 a.m., 1:00 p.m., and 8:00 p.m.) for ten days. Thereorder time is at 8:00 a.m. The reorder level is one days supply, andthe target level is four days supply. For the above medication order(setting forth administration three times per day), the reorder level isthree items (1 day×3 items), and the target level is twelve items (4days×3 items). The system may be able to identify current levels inanalyzing reorder quantities, and thus may identify when anadministration was skipped (e.g., day 3).

TABLE 1 Day of week Mon Tues Wed Thur Fri Sat Sun Mon Tues Wed Day # Dy1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10 ReorderQty-Doses 12 0 0 0 11 0 0 6 0 0 Med needed 8 am order QOH 12 9 6 4 12 96 9 7 4 stopped Dose given 9 am 1 1 0 1 1 1 1 1 1 1 Dose given 1300 1 11 1 1 1 1 1 1 1 Dose given 2100 1 1 1 1 1 1 1 0 1 1 QOH 9 6 4 1 9 6 3 74 1

Table 1, therefore, illustrates an example of an embodiment in which thereorder levels and target levels may be measured in terms of days ofuse. The actual reorder levels and target levels may vary depending onthe rate of use and amount of the medication order remaining to betaken. For example, if the medication order changed, the reorder leveland target level may change as a function thereof.

The reorder process described herein may include both active and futuremedication orders. Table 2 illustrates an example of a series of activeand future medication orders for Drug B. It also illustrates how amountsattributable to a days supply (either target or reorder) may vary overtime. Drug B is to be administered, in decreasing amounts, 1 time perday (at 9:00 a.m.) for 6 days.

TABLE 2 MO # Med Order Item MO Dose QTY MO Start time MO Stop time 1Drug B 30 mg × 1 Drug B 10 mg 30 mg 3 10/1/07 0900 10/1/07 0900 2 Drug B20 mg × 1 Drug B 20 mg 20 mg 1 10/2/07 0900 10/2/07 0900 3 Drug B 10 mg× 1 Drug B 10 mg 10 mg 1 10/3/07 0900 10/3/07 0900 4 Drug B 5 mg × 1Drug B 5 mg  5 mg 1 10/4/07 0900 10/4/07 0900 5 Drug B 2.5 mg × 1 Drug B2.5 mg 2.5 mg  1 10/5/07 0900 10/5/07 0900 6 Drug B 1 mg × 1 Drug B 1 mg 1 mg 1 10/6/07 0900 10/6/07 0900

To determine the target level on 10/1/07, medication orders 1, 2, and 3would be considered. To determine the target level on 10/2/07,medication orders 2, 3, and 4 would be considered. To determine thetarget level on 10/5/07, medication orders 5 and 6 would be considered.Table 2, therefore, also illustrates how varied use rates and endingdates may impact days supply calculations.

In one embodiment, a reorder quantity may be updated before anidentified reorder quantity is delivered to a dispensing device. Forthis example, refer to FIG. 1A and consider an instance when a firstmedication order is processed by the central server computer system 105.A reorder quantity to bring the supply up to the target level isidentified and transmitted (e.g., to a central dispensing unit 115 ofFIG. 2). Assume, for purposes of this example, that the items have beendispensed and labeled, but not delivered to the cabinet (e.g., they arestill located at the central dispensing unit 115).

A second medication order may then be received before the cabinet 220-cis restocked. In certain circumstances, the reorder quantities may bechanged before restock by the processing of the second medication order.In one embodiment, if the current supply at the cabinet plus the reorderquantity from the first medication order is below the reorder level, themodified reorder quantity will be identified and transmitted. However,if the current supply at the cabinet plus the reorder quantity from thefirst medication order is above the reorder level and below the targetlevel, the reorder quantity will not be changed. If the current supplyat the cabinet plus the reorder quantity from the first medication orderis above the target level, the reorder quantity will be changed andtransmitted only if the items to be stocked would not be used by thepatient. A number of other reorder scenarios are possible as well. Forexample, a medication order may be discontinued or the patientdischarged after the initial order list has been gathered at a centraldispensing unit 115 but before the cabinets are restocked. In thisscenario, the restock update may direct a user to remove items fordiscontinued medication orders and discharged patients from the restocklist before proceeding to the cabinets.

Turning to a restock list generated by and received from an externalsystem, there may be certain additional steps in processing such a list.When lists are received from external sources, items and patients may bevalidated to check whether any subset of the patients or items on thelist cannot be handled. Once an external list is so filtered, any of thesteps described above may be performed to generate a restocking list ofitems and quantities to restock.

Referring next to FIG. 21, a flow diagram illustrates an embodiment of amethod 2100 of identifying items of a medication order to be reorderedfor a patient. This method 2100 may, for example, be performed in wholeor in part by the central server computer system 105 of FIG. 1A or 2.Alternatively, the method 2100 may be performed in whole or in part by acomputer associated with a dispensing device 120 or 220 of FIG. 1A, 1B,or 2.

At block 2105, a medication order is received for the patient. At block2110, the medication order is compared to a list of medications storedin ISBs at a dispensing device to determine a subset of items of themedication order to be stored in the PSBs for the patient at the device.At block 2115, a reorder level triggering reorder of respective items isautomatically identified. At block 2120, a determination is made for theitems as to whether the one or more PSBs for the patient at the deviceare at or below the identified reorder levels.

Referring next to FIG. 22, another embodiment is shown of a method 2200of identifying items of a medication order to be reordered for apatient. This method 2200 may, for example, be performed in whole or inpart by the central server computer system 105, the computer associatedwith a dispensing device 120 or 220, or any combination thereof

At block 2205, a medication order is received for the patient (e.g., bya receiving unit of the central server computer system configured toreceive data). At block 2210, the medication order is compared to a listof medications stored in ISBs at a dispensing device to determine asubset of items of the medication order to be stored in the PSBs for thepatient at the device. At block 2215, a reorder level triggering reorderof respective items is automatically identified. At block 2220, adetermination is made for the items as to whether the one or more PSBsfor the patient at the device are at or below the identified reorderlevels. At block 2225, for items determined to be at or below theidentified reorder levels, a reorder amount is determined for thepatient at the dispensing device.

At block 2230, data specifying the reorder amount may be transmitted(e.g., by a transmitting unit of the central server computer system).For example, the data specifying the reorder amount may be transmittedto a pharmacy to generate a restocking list, or be transmitted in theform of a restocking list.

Referring next to FIG. 23, an embodiment of a method 2300 of generatinga restocking list for one or more cabinets is described. This method2300 may, for example, be performed in whole or in part by the centralserver computer system 105, the computer associated with a dispensingdevice 120 or 220, or the central dispensing unit 115. In thisembodiment, the dispensing device is a cabinet.

At block 2305, a request is received to generate a restock list for oneor more cabinets. At block 2310, patients associated with each cabinetare identified (e.g., using rooms table 210-a). At block 2315,medications are identified which are required for each patient but notstocked in ISBs in the cabinet associated with the patient. At block2320, a target level for each item is determined based on the scheduleand dosage of the medication order and a target days supply. At block2325, an amount of the items for each patient is determined based oncurrent quantity in the PSB for the patient and the target level.

Referring next to FIG. 24, an embodiment of a method 2400 of determiningreorder amounts is described. This method 2400 may, for example, beperformed in whole or in part by the central server computer system 105,the computer associated with a dispensing device 120 or 220, or anycombination thereof.

At block 2405, a medication order is received for the patient. At block2410, a dispensing device associated with the patient is identified(e.g., based on an association between a room and the dispensingdevice). At block 2415, the received medication order is compared to alist of medications stored in ISBs at the dispensing device to determinethose items of the medication order that are to be stored in the PSBsfor the patient at the device.

At block 2420, the reorder levels triggering reorder of respective itemsis automatically identified. At block 2425, current levels of supply areidentified for the respective items at the patient's PSB at thedispensing device (e.g., via transmissions from the device). At block2430, the current levels are compared to the reorder levels to determinewhether each of the respective items is to be reordered

At block 2435, a target level is identified, the target level indicatingthe level to which to bring the supply of each respective item for thepatient in restocking the device. At block 2440, the current level iscompared to the target level to identify the respective reorder amounts.At block 2445, data is transmitted specifying the reorder amounts. Atblock 2450, an updated medication order is received (e.g., before therestocking has actually occurred), the order modifying reorder andtarget levels. At block 2455, data is transmitted specifying changedreorder amounts for only a subset of the medications with modifiedtarget levels.

III. Patient-Specific Bin Assignment: Various methods for assigning aPSB in a dispensing device to a patient are described. In oneembodiment, a room or area to be occupied by a patient is associatedwith a dispensing device (e.g., via the rooms table 210-a). One or moreavailable PSBs in the dispensing device are automatically identifiedwhen one or more medications are to be stored for the patient. Anavailable PSB in the dispensing device is then be assigned to thepatient.

A set of example embodiments will now be described with reference toFIG. 2. It is worth noting, however, that the functions described may beperformed by the central server computer system 105 of FIG. 1A or 2, thecomputer associated with a dispensing device 120 or 220 of FIG. 1A, 1B,or 2, or any combination thereof. The system 200 includes a number ofdispensing devices 220 in communication with a central server computersystem 105 at a healthcare facility. Each dispensing device 220 may beassociated with one or more rooms or areas, and a patient (among anumber of patients at the healthcare facility) is assigned to one of therooms. A particular nursing unit cabinet 220-c is associated with theroom assigned to the patient (e.g., via rooms table 210-a). In otherembodiments, a range of other types of dispensing devices 120, 220 maybe used, configured to dispense medications to areas or other groups ofrooms in a healthcare facility.

In one embodiment, the nursing unit cabinet 220-c associated with thepatient includes one or more PSBs assigned for exclusive use to apatient, and one or more ISBs each allocated for an item available to beused by the plurality of patients. An ISB is a bin which may be assignedto an item independent of the item's relation to a patient (e.g., it maybe for use among two or more patients). The central server computersystem 105 may dynamically re-allocate the bins for patient- oritem-specific use, or the allocation may be static.

The central server computer system 105 may automatically identify one ormore available PSBs from the bins within the cabinet 220-c. To do so,the central server computer system 105 may receive data from the cabinet220-c, or elsewhere, identifying whether particular PSBs are currentlyassigned. Thus, the central server computer system 105 or the cabinet220-c computer may monitor the assignments and usage. The central servercomputer system 105 may assign one or more of the available PSBs to thepatient.

In one embodiment, the assignment of the PSB to the patient is based ona selection from a number of available PSBs by a user through agraphical or other interface at the cabinet 220-c. The central servercomputer system 105 may transmit a selectable user interface configuredto display the identified PSBs, and receive a selection via theselectable user interface (e.g., transmitted from the cabinet 220-c). Inan alternative embodiment, an assignment of an available PSB to thepatient is made automatically and transmitted to the cabinet 220-c oruser.

Once assigned, the central server computer system 105 may be configuredto receive information (e.g., transmitted from a cabinet 220-c)indicating that an assigned PSB has insufficient available capacity forthe medications to be stored. The system 105 may be configured toautomatically identify one or more additional available bins to providesufficient storage capacity for the identified medications.

In one embodiment, a central server computer system 105 may determinethat the cabinet 220-c associated with the room does not currentlyinclude one or more available bins allocated as PSBs. In this instance,the system 105 may allocate one or more available bins (e.g., as PSBsbased on the determination). Thus, the central server computer system105 may assign a PSB from this allocation of bins as well.

The central server computer system 105 may receive a listing ofmedications to be stored for the patient in one or more PSBs (perhapsfrom a medication order or a restock list). Such a listing may be basedon current or future orders. To identify medications of the listing thatare to be stored in PSBs, a comparison may be made to a listing of themedications at the cabinet 220-c stored in ISBs (e.g., as common stock).The central server computer system may transmit data identifyingmedications of the listing to be stored in one or more PSBs.

The central server computer system 105 may determine storagerequirements associated with the received listing of items. Storagerequirements may include, for example, control level restrictions, userlevel control access requirements, other physical or technical securityrequirements, storage type requirements (e.g., refrigeration, thephysical configuration, etc.), storage restrictions (e.g., respiratoryor other item group restrictions), and storage capacity requirements.The automatic identification of available PSBs may be based on thedetermined storage requirements (e.g., matching the characteristics ofthe available PSBs to the storage requirements of the received listing).Thus, in certain embodiments, only those available PSBs meeting certainstorage requirements are identified as available.

The central server computer system 105 may also determine whetheridentified PSBs are eligible to store the particular medications to bestored for the patient, and conversely determine whether the patient iseligible for assignment to the identified available bin. Thiseligibility may be based on status issues for the patient (e.g., theassignment limitations associated with active, interim, or inactivestatus). Thus, in certain embodiments, only those available PSBs meetingcertain eligibility criteria are identified as available for a patient.

In another embodiment, the central server computer system 105 maydetermine that the PSBs assigned to the patient in the cabinet 220-chave insufficient available capacity for identified medications. Thesystem may also determine that the cabinet 220-c associated with theroom does not currently include an available bin allocated as a PSB andconfigured with sufficient capacity to store the identified medications.Because of such issues, one or more available bins in the cabinet 220-cmay be re-allocated as PSBs. This re-allocation may be based on adetermination of sufficient storage capacity at the bin to bere-allocated. In other embodiments, bins may be automaticallyre-allocated (from ISBs to PSBs, or vice-versa) based on current orfuture projections for patient-specific storage at the cabinet 220-c orwider group of dispensing devices 220.

When a user is ready to stock a cabinet 220-c, the user may log-in orotherwise register at the cabinet 220-c. Alternatively, a user mayinitiate an action (e.g., a restock, or a first use of a multi-use item)which requires an identification of a PSB. The central server computersystem 105 may then automatically identify an already assigned PSB forstorage of medications for the patient, transmitting the identificationto the cabinet. Similarly, a computer at the cabinet 220-c may beconfigured to automatically direct the user, as well.

Referring next to FIG. 30, one embodiment of a method 3000 of assigninga bin to a patient is illustrated. This method 3000 may, for example, beperformed in whole or in part by the central server computer system 105of FIG. 1A or 2. Alternatively, the method 3000 may, for example, beperformed in whole or in part by a computer associated with a dispensingdevice 120 or 220 of FIG. 1A, 1B, or 2.

At block 3005, identification of a room to be occupied by a patient isreceived. At block 3010, a dispensing device associated with the room isidentified. At block 3015, one or more available PSBs in the dispensingdevice are automatically identified. At block 3020, the patient isassigned to a selected one of the available PSBs.

Referring next to FIG. 31, another embodiment of a method 3100 ofassigning a bin is illustrated. This method 3100 may, for example, beperformed in whole or in part by the central server computer system 105,the computer associated with a dispensing device 120 or 220, or anycombination thereof.

At block 3105, a dispensing device associated with a room of a patientis identified, the dispensing device including PSBs and ISBs. At block3110, a listing of medications to be stocked for the patient in one ormore PSBs is received. At block 3115, control, security, storage type,and storage capacity requirements for each listed medication areidentified. At block 3120, PSBs able to accommodate the requirements areautomatically identified. In some embodiments, only PSBs associated witha given item group may store items from that item group. At block 3125,each listed medication is associated with one or more of theautomatically identified PSBs assigned to the patient.

Turning to FIG. 32, an alternative embodiment of a method 3200 ofassigning a PSB is illustrated. This method 3200 may, for example, beperformed in whole or in part by the central server computer system 105,the computer associated with a dispensing device 120 or 220, or anycombination thereof.

At block 3205, identification of a room to be occupied by a patient isreceived. At block 3210, a dispensing device associated with the room isidentified, the dispensing device including PSBs and ISBs. At block3215, a listing of medications to be stocked for the patient in one ormore PSBs is received. At block 3220, a determination is made as towhether PSBs currently assigned to the patient are eligible to store oneor more items of the listing and also are configured with sufficientstorage capacity. If so, the process jumps to block 3245 to generate aninterface with a prioritized listing of one or more PSBs assigned to apatient which are both eligible and configured with sufficient capacity.

If the PSBs currently assigned to the patient are insufficient, adetermination is made at block 3225 as to whether there are availablePSBs both eligible to store the listed items and configured withsufficient capacity. If no such bins are available, the processcontinues at block 3230, where one or more available ISBs eligible tostore listed medications and configured with sufficient storage capacityare re-allocated as PSBs (or, in another embodiment, empty PSBs assignedto other patients may be identified and converted to available PSBs).From either block 3225 or block 3230, the process continues at block3235, wherein one or more of the available PSBs are identified aseligible to store listed medications and configured with sufficientstorage capacity. At block 3240, at least one of the PSBs identified atblock 3235 is automatically assigned to the patient. From block 3240,the process advances to block 3245 to generate an interface withprioritized listing of one or more eligible PSBs assigned to the patientconfigured with sufficient capacity.

From block 3245 (regardless of the manner in which it was reached), themethod proceeds to block 3250, where a selection of item assignments toPSBs is received via the interface. At block 3255, items are assigned toselected PSBs. In other embodiments, the selection and assignment ofitems to PSBs may be automatic.

Referring next to FIG. 33, an embodiment of a method 3300 of assigning aPSB is illustrated. As above, the method 3300 may, for example, beperformed in whole or in part by the central server computer system 105,the computer associated with a dispensing device 120 or 220, or anycombination thereof.

At block 3305, an identification of a room to be occupied by a patientis received. At block 3310, a dispensing device associated with a roomof the patient is identified, the dispensing device including PSBs andISBs. At block 3315, a listing of medications to be stocked for thepatient in one or more PSBs is received.

At block 3320, a determination is made whether PSBs are available at thedispensing device. If so, at block 3325 a determination is made whetherPSBs are configured with sufficient capacity. If so, at block 3345, PSBsare identified, the identification prioritizing a configuration bettersuited to store the items of the listing of medications.

If no PSBs (e.g., either assigned or unassigned) are available, or ifthose available are configured with insufficient capacity, availableISBs are identified at the dispensing device at block 3330. At block3335, those available ISBs with sufficient storage capacity areidentified. At block 3340, one or more identified available ISBs areallocated for use as PSBs. From block 3340, one of the newly allocatedPSBs is identified at block 3345, the identification prioritizing aconfiguration better suited to listing of medications.

From block 3345 (regardless of the manner in which it was reached), thePSB is assigned to the patient at block 3350. At block 3355, theassignment information is transmitted to the PSB. At block 3360, bins atthe dispensing device are automatically re-allocated based on futureprojections (e.g., projections based on estimated future use).

IV. Management of Patient Transfers: There are various systems, methodsand device configurations for managing the location of medicationsassociated with the transfer of a patient to a new location. Thefunctions described related to managing such a transfer may be performedby the central server computer system 105 of FIG. 1A or 2, the computerof dispensing device 120 or 220 of FIG. 1A. 1B, or 2, or a combinationthereof. The steps may be performed by the computer of the dispensingdevice 120 or 220 associated with the originating or terminatinglocation.

In one embodiment, the process is initiated when information is receivedindicating that the patient is to be transferred from a current roomserved by a first cabinet to a new room served by a second cabinet. Anidentification is made of medications assigned to the patient that arestored at the first cabinet and are to be transferred. The binconfiguration for such medications at the first cabinet is identifiedand stored. The stored bin configuration data may then be applied to thesecond cabinet for bin assignment purposes (the second cabinetinheriting one or more PSB attributes from the first cabinet), andthereby leveraging the tuning performed at the first cabinet.

In one embodiment, the process is triggered when information is received(e.g., at the central server computer system 105) that a patient is tobe transferred to a new room or area served by a different dispensingdevice 120. This may be a patient transfer that has occurred in thepast, will occur in the future, or is currently in process (e.g., when apatient is en route). Particular components may, but need not, possessreal-time data regarding the physical location of the patient. By way ofexample, a central server computer system 105 may receive a set of datawhich is generated as notice of a transfer (e.g., automatically createdby user action at a dispensing device 120 and transmitted to the centralserver computer system 105).

The central server computer system 105 may identify medications storedin the one or more PSBs assigned to the patient at the originatingdispensing device, and store a set of data identifying the binconfiguration. To perform this identification, the central servercomputer system 105 may automatically identify (e.g., in response to atransfer notification) medications to be transferred from the firstoriginating device to the destination dispensing device for the patient.The bin configuration data may be limited to bins storing medications tobe transferred. The central server computer system 105 may alsoautomatically identify discontinued medications for the patient, whichmay be removed and returned. The bins containing only discontinued itemsmay be excluded from the stored bin configuration data.

This bin configuration data may include characteristics of each PSBstoring the identified items (bin type, bin size, bin location,security, etc.). It may include a list of the items stored in respectivePSBs, characteristics of each item stored (amount, control level,security requirements, refrigeration requirement, storage needs, etc.),and any other capacity utilization data (e.g., proportion of capacityused). The bin configuration data may be collected by accessing orotherwise auditing information on the patient or dispensing device indata store 110 or a central dispensing unit 115 (e.g., accessing anactive or future medication order). As addressed above, identificationand bin configuration may be initiated by the receipt of the transfernotification, or may otherwise occur before or after receipt of thetransfer notice. In one embodiment, the change of status of a bin (e.g.,from active to interim) may trigger the identification of medicationsand the storage of bin configuration data before or after actual patienttransfer.

The bin configuration may then be applied to the dispensing deviceassociated with transfer location, so that tuning performed at theoriginating location may be transferred. For example, the central servercomputer system 105 may be configured to apply the stored set of binconfiguration data by automatically identifying a bin configuration forthe second dispensing device based on the configuration of certain PSBsassigned to the patient at the originating dispensing device. All, oronly part, of the bin configuration data may be used in assigning binsat the dispensing device at the transfer location. For example, items indifferent PSBs at the originating device may be combined into a singlebin at the transfer location, while items with different control levelsmay be placed in separate bins. Thus, the original PSB configuration maybe leveraged to varying degrees, as it may be identical, have onlycertain parts mirrored, or only have aspects used in a more limitedmanner.

There are a number of factors in determining how bin configuration datais applied to the destination dispensing device 120. The destinationdevice 120 may have a different configuration, so in some instances onlycertain aspects of the original bin configuration may be transferable.The destination device 120 may already be storing medications inlocations that prevent or inhibit identical configurations from beingused. In some instances, bins may be re-allocated (e.g., from ISBs orother bin types) to PSBs to allow aspects of the originating binconfiguration to be applied to the destination device 120, or for otherpurposes.

In one embodiment, the proportion of capacity used for certain bins orsets of bins at the originating device 120 may be determined. Theapplication of the bin configuration data to the destination device 120may be limited to only those bins or sets of bins using greater than acertain proportion of capacity (e.g., only apply bins over 50% full, andconsolidate remaining medications). Thus, there may be rules providingthat only bins filled over a threshold proportion of capacity areapplied to the second dispensing device. The preceding embodiments onlyrepresent examples of the different extent to which tuning may beleveraged.

The listing of medications to be transferred and the configuration datamay be transmitted (e.g., by the central server computer system 105) tothe destination dispensing device 120. The transmitted configurationdata may identify specific bins for storage of each of the items fromthe listing of medications. The destination device 120 may be a PSBwhich inherits certain attributes of the originating dispensing device,or may be a non-PSB cabinet which uses the information in another manner(e.g., to identify storage needs).

It is also worth noting that bin configuration data may be applied toother devices in addition to the destination device 120. For example,consider an example in which medications are identified which are to bestored in a different dispensing device. If all or part of thesemedications are similar to the medications stored in the originatingdevice 120 (e.g., have greater than a threshold correlation withmedications stored for the patient in that device), the stored binconfiguration data from the originating device 120 may be applied to thedifferent dispensing device. In this way, tuning performed on certainmedications may be leveraged beyond the destination device 120.

Turning to FIG. 40, an example of a system 4000 is illustrated formanaging medications during a patient transfer between rooms served bydifferent dispensing devices. The illustrated system 4000 includes twodispensing devices, dispensing device-a 4010-a and dispensing device-b4010-b. Each device may, for example, be a dispensing device 120 or 220of FIG. 1A, 1B, or 2, and thus may be a cabinet with a number of binsfor dispensing medical supplies (e.g., pharmaceuticals, othermedications, or other supplies for a patient at a healthcare facility).For purposes of example, assume that the items to be transferred aremedications.

The system 4000 also includes a central server computer system 4005,which is communicatively connected with each dispensing device 4010. Thecentral server computer system 4005 may be the central server computersystem 105 of FIG. 1A or 2. The system also includes a pharmacydispensing unit 4020, which may be the central dispensing unit 115 ofFIG. 1A, 1B, or 2. The pharmacy dispensing unit 4020 is alsocommunicatively connected to the central server computer system 4005.The system may include any other number of connected dispensing devices(not shown), and thus the illustrated embodiment is for purposes ofexample only. Moreover, the following illustrates functionality forpurposes of example only, and many other scenarios are possible.

Dispensing device-a 4010-a may be associated with location-a 4015-a.This association may indicate that dispensing device-a 4010-a is acabinet at a nursing station serving a set of rooms which includeslocation-a 4015-a. Assume that in this example, a patient at thehealthcare facility is initially located in a room within location-a4015-a, and the central server computer system 4005 may reflect thisassociation. However, in other embodiments, location-a 4015-a may be apast or future location for the patient, or be another type of room orlocation (e.g., an operating room, an emergency room, a transitorylocation between two rooms, etc.).

A medication order may be generated for the patient and routed to thepharmacy dispensing unit 4020. The medications specified in the ordermay then be placed in a cart at the pharmacy dispensing unit 4020 fordelivery 4030 to dispensing device-a 4010-a. Medication is then stockedand/or restocked for the patient in one or more PSBs at dispensingdevice-a 4010-a.

The patient is then scheduled to be transferred 4025 from location-a4015-a to location-b 4015-b. Either before, during, or after thephysical transfer of the patient and/or the transfer of certainmedications, bin configuration data is stored for PSBs of the patient atdispensing device-a 4010-a. The bin configuration information may belimited to PSBs holding medications to be transferred, and perhapsmeeting other criteria (as noted above). At least some medicationsstored in PSBs at dispensing device-a 4010-a are transferred 4035 to anew dispensing device associated with the new location (morespecifically, dispensing device-b 4010-b associated with the transferroom at location-b 4015-b).

The bin configuration data from dispensing device-a 4010-a may then beapplied, to differing degrees, in assigning PSBs to hold the transferredmedications at dispensing device-b 4010-b. The tuning performed atdispensing device-a 4010-a may be analyzed to determine which aspectsshould be applied at dispensing device-b 4010-b. As discussed above, binconfiguration may be mirrored or have only certain aspects applied.

An example of the bin configuration data that may be stored and analyzedis illustrated in FIG. 41. In this embodiment, the bin configurationdata is stored as a table 4100. The bin configuration data may be storedby and/or transmitted to or from the central server computer system 105of FIG. 1A or 2 or the computer of dispensing device 120 or 220 of FIG.1A, 1B, or 2.

The bin configuration data includes information regarding bin type 4105,bin storage space 4110, bin security 4115, and bin location in cabinet4120. Other embodiments may include more or fewer bin characteristics.The bin configuration data may also include the types of medicationsstored 4125, the amount 4130, and the security requirements 4135. Inother embodiments, more or fewer medication characteristics may beincluded. Capacity utilization information 4140 may also be included foreach, or for a set, of bins.

Referring next to FIG. 42, one embodiment of a method 4200 of managing apatient transfer is illustrated. This method 4200 may, for example, beperformed in whole or in part by the central server computer system 105,the computer associated with a dispensing device 120, or 220, or anycombination thereof. Also, it is worth noting that in this and in otherembodiments, various steps may be excluded, and the order may berearranged.

At block 4205, transfer data is received indicating that a patient is tobe transferred from an originating location associated with a firstdispensing device to a transfer location associated with a seconddispensing device. At block 4210, bin configuration data is storedidentifying a configuration of PSBs assigned to the patient at the firstdispensing device. At block 4215, the stored bin configuration data fromthe first dispensing device is applied to the second dispensing device.

Referring next to FIG. 43, an example of a method 4300 of assigning PSBsat a dispensing device associated with the transfer destination for apatient is shown. In this embodiment, the dispensing device is acabinet. This method 4300 may, for example, be performed in whole or inpart by the central server computer system 105, the computer associatedwith a dispensing device 120 or 220, or any combination thereof.

At block 4305, a patient with assigned PSBs is physically moved to a newlocation prior to notification of new patient location. The assignedPSBs may be at the cabinet associated with the patient's previouslocation and, thus, that cabinet may remain as the currently activecabinet even after the patient has physically been moved. At block 4310,the bin configuration at the cabinet associated with the patient'sprevious location may be received (e.g., by the central server computersystem 105 from the currently active cabinet). This bin configurationinformation may include the list of items to be transferred.

At block 4315, information is received that the patient has physicallymoved to a new location. The new location may be identified with thereceived information. At block 4320, PSBs for a new cabinet associatedwith the new location are automatically assigned, based at least in parton the received bin configuration and available bins at the new cabinet.In this manner, the received bin configuration information may beapplied to the new cabinet. At block 4325, the PSB assignments aretransmitted to the new cabinet.

Referring next to FIG. 44, an example of an alternative method 4400 ofassigning PSBs at a dispensing device associated with the transferdestination for a patient is shown. In this embodiment, the dispensingdevice is again a cabinet. This method 4400 may, for example, beperformed by the central server computer system 105, a computer ofdispensing device 120 or 220, or any combination thereof.

At block 4405, information is received that a patient with PSBs has beenassigned to a new location before a physical move to a new location. Theassigned PSBs may be at the cabinet associated with the patient'scurrent, but temporary, location. This may be any form of notificationof a transfer. The cabinet associated with the new location may therebybecome the active cabinet, despite the fact that the patient has yet todepart from his current location.

At block 4410, the previously active cabinet (e.g., associated with thelocation where patient and his or her PSBs are located) is designated asthe interim cabinet to allow continued functionality until the patientis physically moved. At block 4415, information is received that thepatient has physically moved to the new location, triggering removal ofitems from the interim cabinet. Upon removal, inactive items may beidentified (perhaps by the central server computer system 105) andreturned (e.g., to a pharmacy or return bin). The list of items to betransferred may be maintained by the central server computer system 105,or received from the interim cabinet (which may then become inactive).

At block 4420, the bin configuration information (including the list ofitems being transferred) is transmitted to the newly active cabinet(e.g., by the central server computer system 105). This active cabinetcomputer may assign PSBs to the patient and direct placement of theitems automatically based on the originating bin configuration. In thismanner, the bin configuration information may be applied to the newcabinet by the computer at the active cabinet. At block 4425, the newPSB assignments and item locations are received (e.g., by the centralserver computer 105) from the active cabinet.

Referring next to FIG. 45, an example of an alternative method 4500 ofapplying bin configuration data to a dispensing device associated withthe transfer destination for a patient is shown. In this embodiment, thedispensing device is again a cabinet. This method 4500 may, for example,be performed by the central server computer system 105, a computer ofdispensing device 120 or 220, or any combination thereof.

At block 4505, transfer data is received indicating that a patient is tobe transferred (in the past, or in the future) from an originatinglocation associated with a first dispensing device to a transferlocation associated with a second dispensing device. At block 4510,discontinued medications for the patient to be removed from the firstdispensing device are identified. This may be done by comparing theactive medication order to the listing of medications stored in the PSBsto identify medications that are discontinued. At block 4515,medications for the patient to be transferred from the first dispensingdevice to the second dispensing device are identified, the medicationsto be transferred exclusive of the discontinued medications.

At block 4520, bin configuration data is compiled identifying theconfiguration of the PSBs of the patient at the first dispensing devicestoring the medications to be transferred, the configuration dataincluding type, size, location, and security parameters. Thiscompilation may be performed by auditing a record (e.g., the bins table210-b and/or items table 210-c) of medications to be transferred and thePSBs storing such medications. At block 4525, the proportion of capacityused for each of the patient's PSBs at the first dispensing device isdetermined by correlating the configuration data with physicalcharacteristics of the identified medications (or container thereof) tobe transferred. The capacity utilization may be determined by analyzingthe bin size in light of the physical dimensions of the medicine(s)and/or container(s) stored therein.

At block 4530, those bins of the patient at the first dispensing devicewith capacity utilization over a threshold utilization level areidentified (e.g., useable space utilization above 70%). At block 4535, afirst set of available PSBs at the second dispensing device isidentified which matches bins over the threshold utilization level.However, in this embodiment assume that there are not enough availablePSBs of proper sizes/characteristics to match all of the bins from thefirst dispensing device that are above the threshold utilization level.

Therefore, at block 4540, other available bins (e.g., available ISBs, orPSBs currently assigned to a patient and not in use) at the seconddispensing device are identified that match any remaining unmatched binsover the threshold utilization level. At block 4545, the otheridentified available bins at the second dispensing device arere-allocated as available PSBs. At block 4550, a second set of availablePSBs at the second device is identified to store transferred medicationsfrom the bins at the first dispensing device under threshold utilizationlevel. At block 4555, the stored bin configuration data from the firstdispensing device is applied to the second dispensing device byassigning the first and second sets of identified PSBs and the binsre-allocated as PSBs to the patient.

V. Removal or Return of Items Associated with a Patient-Specific Bin: Inother embodiments, functionality is described for the removal and returnof medications that has been allocated or assigned to specific patients.Various procedures are set forth for the removal of items from PSBs.Also, procedures are described for the return of items which areprepared and ready to be stocked or restocked in PSBs (e.g., medicationsin a cart ready to be placed in a PSB). The removal and return of suchmedications may be referred to as a cleanup.

In certain embodiments, items are removed or returned to a centraldispensing unit (e.g., a pharmacy) because there is a discontinued orotherwise changed medication order, or surplus medication in a PSB. Theremoval or return may also be initiated by a transfer or discharge. Thecleanup functionality described herein may be performed by the centralserver computer system 105 of FIG. 1A or 2, a dispensing device 120 or220 computer of FIG. 1A, 1B, or 2, or a combination thereof.

There are a variety of actions that may trigger a cleanup. For example,a cleanup may be triggered by an input request of a user to stock orrestock a patient's PSBs at a dispensing device 120. The attempt by auser to transfer items to a new active dispensing device 120 may alsotrigger cleanup at the originating or transfer location. A notificationthat a patient will be soon be discharged, or an attempt to return apatient's own medicine to a patient upon discharge, may trigger cleanup.A change to a medication order (e.g., discontinuing a medication orchanging a dose) may do so, as well. A cleanup may be triggered as partof a regularly scheduled cleanup. The central server computer system 105or dispensing device 120 computer may be configured to have a variety ofother actions trigger a cleanup, as well.

By way of example, a central server computer system 105 may receive aset of data which is generated as notice of a triggering event for apatient (e.g., automatically created by user action at a dispensingdevice 120 and transmitted to the central server computer system 105).The central server computer system 105 may identify medications storedin the one or more PSBs assigned to the patient (or medications inpossession of a user to be stocked or restocked therein), and may alsoidentify a medication order associated with the patient. Theseidentifications may, for example, be made by accessing information onthe patient or dispensing device in data store 110 or a centraldispensing unit 115. The identifications may be initiated by the receiptof the triggering data, or may occur before receipt of the triggeringdata.

When a cleanup is triggered, a determination may be made whether thepatient is to be discharged. If so, the medications and other suppliesof the patient stored in the PSBs may be identified, and their removaldestinations specified (e.g., return to pharmacy, return to patient,etc.). A determination may also be made whether the patient is to betransferred within the healthcare facility. If so, items stored in thePSBs without an active medication order (e.g., discontinued medications)may be identified along with a removal destination. This identificationmay be performed by comparing the list of items stored in a PSB for thepatient to a medication order. The remaining items to be transferred,and the current bin configuration, may be stored and/or transmitted(e.g., transmitted to the new dispensing device).

The central server computer system 105 may determine that a patient isnot to be transferred or discharged (e.g., determining that the patientis remaining at the healthcare facility because no notice of dischargeis currently associated with the patient). Absent discharge or transfer,cleanup may be triggered during the stocking, restocking, or periodiccleaning of the PSB for a particular patient, set of patients, orcabinet generally. In any case, the items in PSBs that have beendiscontinued, and other surplus items, may be identified, along with aremoval destination. Similarly, items in a cart to be stocked orrestocked at a dispensing device 120 may be identified and reroutedbecause they have been discontinued or there is a surplus. Theseidentifications of discontinued or surplus items may be performed bycomparing the list of items stored in a PSB for the patient to amedication order.

Thus, the central server computer system 105 may automatically identify,in response to the received set of triggering data, a subset of themedications stored in PSBs that have been discontinued according to themedication order. Thus, the discontinued medications already stored inthe dispensing device 120, or currently set to be stocked or restockedat the device, may be identified. Similarly, if an item is oversupplied(e.g., because of a change in a medication order), the amount ofoversupply may be identified, and a user may be directed to remove someof the items.

The central server computer system 105 may also identify returnlocations for discontinued medications (e.g., by accessing a set ofrules stored in the data stores 110 regarding appropriate returnlocations). The central server computer system 105 may also transmit, toa dispensing device associated with the patient, data directing removalor return of the medications and identifying the return locations.

For each item removed and/or returned, the central server computersystem 105 may be configured to automatically track the item, assemblingthe information and storing it in the data stores 110. The centralserver computer system 105 may receive information that a particularitem has arrived at a particular destination (e.g., an identifier forthe item may be read at the transfer, return, pharmacy, or otherlocation, and transmitted to the central server computer system 105).Items removed during cleanup may be tracked in an ongoing manner, orthis information may be assembled periodically. Thus, removed itemswhich have not reached their destinations may be tracked in real time orperiodically.

Turning to FIG. 50, an example of a system 5000 is illustrated forremoving and/or returning medications stored (or ready to be stored) ina dispensing device which includes PSBs. The illustrated system 5000includes two dispensing devices, dispensing device-a 5010-a anddispensing device-b 5010-b. Each device may, for example, be adispensing device 120, 220 of FIG. 1A, 1B, or 2, and thus may be acabinet with a number of bins for dispensing medical supplies (e.g.,pharmaceuticals, other medications, or other supplies for a patient at ahealthcare facility). For purposes of example, assume that the items tobe removed and/or returned are medications.

The system 5000 also includes a central server computer system 5005,which is communicatively connected with each dispensing device 5010. Thecentral server computer system 5005 may be the central server computersystem 105 of FIG. 1A, 1B, or 2. The system also includes a pharmacydispensing unit 5020, which may be the central dispensing unit 115 ofFIG. 1A, 1B, or 2. The pharmacy dispensing unit 5020 is alsocommunicatively connected to the central server computer system 5005.The system may include any other number of connected dispensing devices(not shown), and thus the illustrated embodiment is for purposes ofexample only. Moreover, the following illustrates functionality forpurposes of example only, and many other scenarios are possible.

Dispensing device-a 5010-a may be associated with location-a 5015-a.This association may indicate that dispensing device-a 5010-a is acabinet at a nursing station serving a set of rooms which includelocation-a 5015-a. Assume that in this example, a patient arrives at thehealthcare facility, and is physically moved 5025 into one of the roomsof location-a 5015-a, and the central server computer system 5005 mayreflect this association. However, in other embodiments, location-a5015-a may be a past or future location for the patient, or be anothertype of room or location (e.g., an operating room, emergency room, atransitory location between two rooms, etc.).

At some time after arrival of the patient at location-a 5105-a, apatient's own medication may be stocked for the patient in a PSB atdispensing device-a 5010-a. A medication order or orders may begenerated for the patient, and routed to the pharmacy dispensing unit5020. The medication or medications specified in the order(s) may thenbe placed in a cart at the pharmacy dispensing unit 5020 for delivery5030 to dispensing device-a 5010-a. A medication order then changeswhile the medications are en route, discontinuing certain medications(e.g., medication order may be discontinued, or a subset of itemstherein may be discontinued). When a user attempts to stock the device,the cleanup is triggered, and the discontinued medications beingdelivered are instead identified for return (e.g., return 5030 to thepharmacy dispensing unit 5020).

While the patient remains at location-a, a new medication order isgenerated for the patient, and routed to the pharmacy dispensing unit5020. As noted above, the term “medication order” may be an orderassociated with one, or more, medications. Thus, a number of medicationorders may be generated for a particular patient at a given time at adevice 5010, or a single medication order may be analyzed including anumber of medications. Thus, it may be assumed that a reference to a“medication order” may be an order associated with a number ofmedications, or to a number of orders each associated with one or moremedications. The new medication order adds certain new medications, anddiscontinues others. New medications specified in the order, as well asmedications to be restocked, may then be placed in a cart at thepharmacy dispensing unit 5020 for delivery 5030 to dispensing device-a5010-a. When a user attempts to restock the device, the cleanup istriggered again, and the discontinued medications are identified forremoval and return (e.g., return 5030 to the central dispensing unit5020).

The patient is then scheduled to be transferred 5035 from location-a5015-a to location-b 5015-b. Assume that a new medication order thendiscontinues certain medications. Either before, or after, the patientis physically transferred 5035 to a new room at location-b 5015-b, themedications stored in PSBs at dispensing device-a 5010-a are to betransferred 5045 to a new dispensing device associated with the newlocation (more specifically, dispensing device-b 5010-b associated withthe transfer room at location-b 5015-b). As a user attempts tophysically remove 5040 the medications stored in PSBs at dispensingdevice-a 5010-a for transfer, a cleanup is triggered. The discontinuedmedications may be identified for return 5030 to the pharmacy dispensingunit 5020.

The medication order again changes while the transferred medications areen route, discontinuing certain medications being transferred. When auser attempts to store 5055 the transferred medications at dispensingdevice-b 5010-b, the cleanup is triggered, and the discontinuedmedications are identified and returned (e.g., returned 5030 to thecentral dispensing unit 5020). The remaining transferred medications arethen stored in dispensing device-b 5010-b.

After the transferred medications are stored, assume that a regularlyscheduled restock is to occur for the patient at dispensing device-b5010-b. Medications to be restocked may then be placed in a cart at thepharmacy dispensing unit 5020 for delivery 5060 to dispensing device-a5010-a. However, the medication order again changes while themedications are en route, discontinuing certain medications that arecurrently set to be restocked. When a user attempts to restockdispensing device-b 5010-b, the cleanup is triggered again, and thediscontinued medications currently being restocked are identified forreturn 5060 to the central dispensing unit 5020. Also, the remainingdiscontinued medications stored in dispensing device-b 5010-b areidentified for removal and return to the central dispensing unit 5020.

The patient is then scheduled for discharge, and a notice of dischargeis received at the central server computer system 5005. Medications tobe given to the patient upon discharge are identified (e.g., a patient'sown medication, or other active medications). As the patient isdischarged 5070, the patient is given 5065 these identified medications.

Referring to FIG. 51, one embodiment of a method 5100 of identifyingdiscontinued items from a PSB assigned to a patient is illustrated. Thismethod 5100 may, for example, be performed in whole or in part by thecentral server computer system 105 of FIG. 1A or 2 or the computer ofdispensing device 120 or 220 of FIG. 1A, 1B, or 2. Also, it is worthnoting that in this and in other embodiments, various steps may beexcluded, and the order may be rearranged.

At block 5105, a set of triggering data is received including notice ofa triggering event. At block 5110, medications stored in a PSB assignedto the patient are identified. At block 5115, a medication orderassociated with the patient is identified. At block 5120, in response tothe set of triggering data, those of the stored medications which havebeen discontinued according to the medication order are automaticallyidentified.

Referring to FIG. 52, one embodiment of a method 5200 of returning itemsto be stocked a PSB assigned to a patient is illustrated. This method5200 may, for example, be performed in whole or in part by the centralserver computer system 105, the computer associated with a dispensingdevice 120 or 220, or any combination thereof.

At block 5205, a set of triggering data is received including notice ofa triggering event. At block 5210, medications to be stocked orrestocked for the patient in PSBs assigned to the patient areidentified. At block 5215, a medication order associated with thepatient is identified. At block 5220, in response to the set oftriggering data, those medications to be stocked or restocked which havethen been discontinued according to the medication order areautomatically identified.

Referring to FIG. 53, one embodiment of a method 5300 of managingcleanup of a dispensing device with PSBs is illustrated. This method5300 may, for example, be performed in whole or in part by the centralserver computer system 105, the computer associated with a dispensingdevice 120 or 220, or any combination thereof.

At block 5305, a set of data is received which triggers cleanup for thePSBs of a particular patient. At block 5310, a determination is madewhether the patient is to be discharged. If so, at block 5315, thepatient's own medication (e.g., medication brought to the healthcarefacility by a patient and under an active or future medication order)may be identified for return to the patient. At block 5320, the itemsremaining in the patent-specific bins (and perhaps other items that wereto be stocked or restocked in the PSBs) are identified, as well as theirdestinations.

If the patient is not to be discharged, a determination is made at block5325 regarding whether the patient is scheduled to be (or has been)transferred from the room or area associated with the dispensing device.If so, at block 5330, discontinued medications (e.g., medicationslocated in PSBs or medications to be stocked or restocked in the PSBs)are identified, along with their removal destination. At block 5335, theremaining items and their current bin configuration may be identifiedand stored. At block 5340, the transfer of the remaining items isdirected (and, perhaps, transmitted to the dispensing device).

If the patient is not to be discharged or transferred, a determinationis made at block 5345 regarding whether any medication to be stored forthe patient in the PSBs (or to be stocked or restocked therein) arediscontinued. If so, at block 5350, inactive items are identified, alongwith their removal destination. At block 5355, any removed items aretracked in an ongoing or periodic manner.

Referring to FIG. 54, an alternative method 5400 of managing cleanup ofa dispensing device with PSBs is illustrated. This method 5400 may, forexample, be performed in whole or in part by the central server computersystem 105, the computer associated with a dispensing device 120 or 220,or any combination thereof.

At block 5405, a user may attempt to stock, restock, or remove itemsfrom a dispensing device, transfer medications in or out of a dispensingdevice, or discharge a patient. In one embodiment, this action may causea set of triggering data to be transmitted providing notice of thetriggering event. At block 5410, the set of triggering data is received,which initiates cleanup for the PSBs of the particular patient. At block5415, a determination is made whether the patient is to be discharged.If so, at block 5420, the medication (e.g., POM or other medicationstocked from the healthcare facility to be provided to the patient) maybe identified for return to the patient. At block 5425, the itemsremaining in the patent-specific bins (and perhaps other items that wereto be stocked or restocked in the PSBs) are identified, as well as theirdestinations.

If the patient is not to be discharged, a determination is made at block5430 regarding whether the patient is scheduled to be (or has been)transferred from a room or area associated with the dispensing device.If so, at block 5435, discontinued medications for the patient locatedin PSBs are identified, along with their removal destination. At block5440, the remaining active items and their current bin configuration maybe identified and stored. At block 5445, the transfer of the remainingitems is directed (and, perhaps, transmitted to the dispensing device).A user may then attempt to stock the transferred medications to the newdispensing device associated with the new room or area. At block 5450,discontinued medications of the transferred medications are identified,along with their destination for return. Thus, if the medication orderis modified in the process of transfer, the discontinued or otherwiseinactive or oversupplied items may be identified and returned (e.g., tothe pharmacy) before they are stocked. At block 5455, the remainingtransferred items may be stocked at the new dispensing device.

If the patient is not to be discharged or transferred, a determinationis made at block 5460 regarding whether any medication is to be storedfor the patient in the PSBs (or to be stocked or restocked therein) arediscontinued. If so, at block 5465, discontinued items are identified,along with their removal destination. At block 5470, any removed orreturned items are tracked in an ongoing or periodic manner.

VI. Handling of POM: In another set of embodiments, various proceduresare described for the handling of medications brought to a healthcarefacility by a patient (often referred to as a patient's own medication,or “POM”). In one embodiment, these are medications brought by a patientand authorized by the prescriber to be administered while hospitalized.These procedures may be performed by the central server computer system105 of FIG. 1A or 2, a computer of dispensing device 120 or 220 of FIG.1A, 1B, or 2, or any combination thereof.

In one embodiment, medications are brought into a healthcare facilityby, for, or on behalf of a patient. These medications may be designatedas POM by a user attempting to store them in a dispensing device, or byother healthcare facility personnel when the medication is collectedfrom the patient upon admittance. By way of example, consider FIG. 1A,and note that a user at the dispensing device 120 or a pharmacist at acentral dispensing unit 115 may input the designation when entering themedications into the system 100. A set of data including the designationand an identifier for the type of medication may be transmitted from theinput device to the central server computer system 105. As set forth inmore detail below, novel storage and removal procedures may be used forPOM designated medications at PSBs.

As described above, a patient may be associated with a dispensing device120, perhaps based on the location of his or her room, or on otherfactors. A dispensing device 120 may include a number of bins allocatedas PSBs and/or ISBs. The POM designation, along with an associatedpatient identifier, PSB, and amount and type information for themedication, may be stored in the data stores 110 by the central servercomputer system 105. Information may also be stored in the dispensingdevice 120 computer. The central server computer system 105 may monitor,track, and direct use of the medications stored in the dispensingdevices 120. It is worth noting that some, or all, or such functions maybe off loaded to a dispensing device 120 computer.

When an item has a POM designation, the central server computer system105 may be configured to exclude the item from the restocking process.For example, in one embodiment, an item with a POM designation is not berestocked until it is used up. In such a case, a restock directive(e.g., generated by the central server computer system 105) would beimplemented only when the supply is used up, at which time the POMdesignation for the item would be removed. Thus restocking of an itemmay be suspended or otherwise prohibited until the quantity on handinformation is equal to zero. Once the medication with the POMdesignation is used up, the standard restocking may occur.

The system 100 may, therefore, be configured to manage and hold itemswith a POM designation separately from medications and other supplies inPSBs. There may be functionality to prevent designated medications frombeing stored in the same PSBs as medication stocked from the healthcarefacility. The bins for PSBs holding POM designated items may bedistinguished from bins holding other items.

In another embodiment, an item with a POM designation may instead berestocked when it falls below a threshold level. This threshold levelmay, but need not, be a different level than would be applied to amedication stocked from the healthcare facility. For example, restockingrules may dictate that for a given medication with a POM designation, arestock will occur when supply falls below 2 days, while restock wouldotherwise occur for the given medication when supply falls below 3 days.While restocking rules may differ, other rules for both the medicationstocked from the healthcare facility and the designated medication maybe the same. For example, allergy rules, contraindication rules, storagesecurity requirement rules, and so on may be the same.

Thus, in light of the above, the same (or similar) types of medicationsmay be stored for a patient in two different PSBs at the same time, onewith a POM designation and another without. The central server computersystem 105 or dispensing device 120 computer may be configured to directuse all of the POM designated items before the same or similar restockeditems are used (e.g., suspending use of the restocked items until thePOM designated items are used up).

When a patient with POM items is transferred, the POM designation may beretained during and after the patient is transferred. In one embodiment,notice may be received that a patient will transfer from a firstlocation to a second location at the healthcare facility. In response tothe notice, a set of data may be transmitted (e.g., from the centralserver computer system) directing the move of the designated medicationfrom a first dispensing device associated with the first location to asecond dispensing device associated with the second location. Thedesignation may be automatically retained during the move. Thus, the POMdesignation may be transferred to the new dispensing device and a newlyassigned PSB when there is a move. The POM designation may be maintainedwhether the medication transfer occurs before, after, or at overlappingtimes with the patient transfer.

When a patient is going to be discharged, a central server computersystem 105 may receive a notice that the patient is to be discharged.This notice may be a set of data sent from a dispensing device 120 orother connected device (e.g., a device in communication with the centralserver computer system 105), indicating that the patient will bedischarged, and perhaps specifying a time or range of times. When apatient is discharged, the central server computer system 105 may beconfigured to identify automatically any items with POM designationsstored in PSBs for the patient, so a user may return the POM item to thepatient. In one embodiment, the central server computer system 105 maydetermine whether the designated medication(s) are under an active orfuture medication order, and only direct the return of those medicationsthat remain under such an order. Once the designated medications (andassociated PSBs) have been identified for return to the patient orretention, a set of data may be transmitted (e.g., to the dispensingdevice 120 computer) directing the return or retention of the designatedmedication.

Turning to FIG. 60, an example of a system 6000 is illustrated fordesignating a POM to be stored in a dispensing device which includesPSBs. The illustrated system 6000 includes two dispensing devices,dispensing device-a 6010-a and dispensing device-b 6010-b. Each devicemay, for example, be a dispensing device 120 or 220 of FIG. 1A, 1B, or2, and thus may be a cabinet with a number of bins for dispensingmedical supplies (e.g., pharmaceuticals, other medications, or othersupplies for a patient at a healthcare facility). The bins may beallocated or assigned as PSBs or ISBs, or have other designations. Forpurposes of this example, assume that the items are medications.

The system 6000 also includes a central server computer system 6005,which is communicatively connected with each dispensing device 6010. Thecentral server computer system 6005 may be the central server computersystem 105 of FIG. 1A or 2. The system may include any other number ofconnected dispensing devices (not shown), and thus the illustratedembodiment is for purposes of example only. Moreover, the followingillustrates functionality for purposes of example only, and many otherconfigurations are possible.

Dispensing device-a 6010-a may be associated with location-a 6015-a.This association may indicate that dispensing device-a 6010-a is acabinet at a nursing station serving a set of rooms which includeslocation-a 6015-a. Assume that in this example, a patient arrives at thehealthcare facility, is physically moved 6020 into one of the rooms oflocation-a 6015-a, and the central server computer system 6005 mayreflect this association.

At some time before or after arrival of the patient at location-a6015-a, POM may be stored 6025 for the patient in a PSB at dispensingdevice-a 6010-a. The PSB in which the POM is stored may be set apartfrom PSBs for the patient storing the medication stocked from thehealthcare facility. There may be a policy to keep such medicationsstored in separate PSBs, preventing POM and medication stocked from thehealthcare facility from being stored in the same bin. A prescriptionfor the patient may include the type of medication making up the POM,and the POM may be administered at the healthcare facility. In oneembodiment, this type of medication for the patient is not restockeduntil the POM is used up; in other embodiments, the restocking levelsfor a POM may differ from restocking levels of the same medicationsstocked from the healthcare facility. The specific restocking levels maydepend on the type of medication, the rate of use, the time required forrestocking, and other related factors.

The patient may then be scheduled to be transferred 6030 from location-a6015-a to location-b 6015-b. Either before, or after, the patient isphysically transferred 6030 to a new room at location-b 6015-b, the POMstored in PSBs at dispensing device-a 6010-a is transferred 6035 to anew dispensing device associated with the new location (morespecifically, dispensing device-b 6010-b associated with the transferroom at location-b 6015-b). The transferred POM may be transferredtogether with medication stocked from the healthcare facility. Thedesignation for each POM may be retained during the transfer, and/orreapplied after the transfer.

When a user stores the transferred medications at dispensing device-b6010-b, the central server computer system 6005 may again direct thatthe POM be stored separately (e.g., in separate bins) from themedications stocked from the healthcare facility. The transferredmedications are then stored in dispensing device-b 6010-b. Again,restocking may occur for the transferred medications (including POM),but may differ depending on the restocking policies of the healthcarefacility and the type of POM transferred.

The patient is then scheduled for discharge, and a notice of dischargeis received at the central server computer system 6005. Medications tobe given to the patient upon discharge are identified (e.g., POM, orother active medications), and the POM may be identified for returnbased on the identification. A set of data identifying these medicationsmay be transmitted to the dispensing device 6010-b. Before the patientis discharged 6045, the patient is given 6040 these identifiedmedications.

Referring next to FIG. 61, one embodiment of a method 6100 ofdesignating medication as a patient's own medication is illustrated.This method 6100 may, for example, be performed in whole or in part bythe central server computer system 105 of FIG. 1A or 2. Alternatively,the method 6100 may, for example, be performed in whole or in part by acomputer associated with a dispensing device 120 or 220 of FIG. 1A, 1B,or 2. Also, it is worth noting that in this and other methodembodiments, various steps may be excluded, and the order may berearranged.

At block 6105, a set of data is received that identifies medicationbrought to a healthcare facility by a patient. At block 6110, themedication is designated as the patient's own medication. At block 6115,the designation for the medication is automatically retained when themedication is transferred between dispensing devices at the healthcarefacility.

Referring to FIG. 62, an example of a method 6200 of designatingmedication to be returned to a patient is shown. By way of example, thismethod 6200 may, for example, be performed in whole or in part by thecentral server computer system 105, the computer associated with adispensing device 120 or 220, or any combination thereof.

At block 6205, a set of data is received that identifies medicationbrought to a healthcare facility by a patient. At block 6210, themedication is designated as POM. At block 6215, the medication isautomatically identified as an item to be returned to the patient whenthe patient is discharged from the healthcare facility, theidentification based at least in part on the designation.

Referring to FIG. 63, an example of a method 6300 of differentiatingbetween certain medications in the assignment of PSBs is shown. Thismethod 6300 may, for example, be performed in whole or in part by thecentral server computer system 105, the computer associated with adispensing device 120 or 220, or any combination thereof.

As in other embodiments, at block 6305, a set of data is received thatidentifies medication brought to a healthcare facility by a patient. Atblock 6310, the medication is designated as POM for the patient. Atblock 6315, the patient is associated with a dispensing device (e.g.,based on an association between a room and a dispensing device). Thedispensing device includes a first set of one or more PSBs assigned forexclusive use of the patient for medication stocked from the healthcarefacility. At block 6320, a second set of one or more PSBs at thedispensing device is assigned to the patient for storage of the POMdesignated medication, the second set distinct from the first set. Thus,there may be a rule to assign POM designated items to different PSBsthan the standard items to be stocked from the healthcare facility. Therule may be automated, or enforced by the user or healthcare facility.

Referring to FIG. 64, an alternative embodiment of a method 6400 ofdesignating medication as a patient's own medication is shown. As inother embodiments, this method 6400 may, for example, be performed inwhole or in part by the central server computer system 105, the computerassociated with a dispensing device 120 or 220, or any combinationthereof.

At block 6405, a patient is associated with a first dispensing device.At block 6410, a set of data is received that identifies medicationbrought to a healthcare facility by a patient. At block 6415, themedication is designated as POM for the patient. At block 6420, a firstset of one or more PSBs at the dispensing device is assigned to thepatient for the POM designated medication. At block 6425, a second setof one or more PSBs is assigned for exclusive use of the patient formedication stocked from the healthcare facility.

At block 6430, different sets of restocking rules are applied tomedication from the healthcare facility than to the POM designatedmedication. At block 6435, certain rules are applied to both medicationstocked from the healthcare facility and the POM designated medication,the same set of rules including allergy rules, contraindication rules,and storage security requirement rules.

At block 6440, a notice is received that the patient will transfer froma first location to a second location at the healthcare facility. Atblock 6445, data is transmitted, in response to the notice, directingthe move of the POM designated medication from the first dispensingdevice to a second dispensing device associated with the secondlocation. At block 6450, the POM designation for the medication isautomatically retained during the move. At block 6455, the POMdesignated medication is identified as an item to be returned to thepatient when the patient is discharged from the healthcare facility, theidentification based at least in part on the designation and adetermination that the medication remains under an active order.

Referring to FIG. 65, yet another alternative example of a method 6500of designating medication as a patient's own medication is shown. As inother embodiments, this method 6500 may, for example, be performed inwhole or in part by the central server computer system 105, the computerassociated with a dispensing device 120 or 220, or any combinationthereof.

At block 6505, a set of data is received that identifies first andsecond medications brought to a healthcare facility by a patient. Atblock 6510, the first and second medications are each designated as POM.At block 6515, a first set of one or more PSBs at a dispensing device isassigned to the patient for the POM designated medications. At block6520, a second set of one or more PSBs is assigned to the patient forexclusive use for medication stocked from the healthcare facility. Arule prevents medication stocked from the healthcare facility from beingstocked in bins assigned to the designated medication.

At block 6525, the first medication is prevented from being restockeduntil the item is used up. At block 6530, restocking of the firstmedication is initiated based on a determination that it is used up. Atblock 6535, the designation is removed from the restocked firstmedication.

Other restocking rules are applied for the second medication (e.g.,based on the type of medication, regularity of use, etc.). At block6540, restock of the second medication is initiated when the secondmedication is not used up, and different restocking rules (e.g., waitinguntil the medication is more depleted before restocking) are applied forthe second medication than for medication stocked from healthcarefacility. At block 6545, use (e.g., user access or patient use) of thesecond medication restocked from the healthcare facility is suspendeduntil the POM designated stock is used up.

VII. Handling of Multi-Use Items: In another set of embodiments, variousprocedures are described for the handling of multi-use items. Multi-useitems are typically dispensers of medication configured for multipleadministrations to the same patient, and may include both the medicationand a container configured to dispense the medication for the patient.Examples may include topical creams, eye drops, and inhalers.

In one embodiment, an unused multi-use item may be initially stored inan ISB available to a number of patients at a dispensing device. Whennotice is received of a first use by a patient of the previously unusedmulti-use item, return of the used multi-use item is directed to a PSBfor the patient in the dispensing device. Once used, the multi-use itemis to be assigned for exclusive use of the patient, and managedaccordingly. In some embodiments, a system differentiates a multi-useitem from a container or dispenser that includes multiple doses that areused or shared by multiple patients. The following procedures describedfor multi-use items may be performed by the central server computersystem 105 of FIG. 1A or 2, a computer associated with dispensing device120 or 220 of FIG. 1A, 1B, or 2, or any combination thereof.

In one embodiment, a multi-use item (e.g., a dispenser of medicationsuch as a tube of topical cream, eye drops, or an inhaler) isidentified. The dispenser of medication (or a stored identifier for thedispenser, e.g., in data stores 110) is associated with a designationindicating that the item is a multi-use item. The multi-use item may bedesignated as such by a user attempting to store the item in adispensing device (e.g., by indicating the designation via an input on adispensing device 120 or 220 computer), or by other healthcare facilitypersonnel when the medication is stored or received at the healthcarefacility. By way of example, consider FIG. 1A, and note that a user atthe dispensing device 120 or a pharmacist at a central dispensing unit115 may input the designation when entering the medications into thesystem 100.

A set of data including the designation and/or an identifier for thetype of medication may be processed and transmitted from an input device(e.g., a dispensing device 120 computer) to the central server computersystem 105, and may be stored in data stores 110. Alternatively, theitem may be automatically recognized as a multi-use item (e.g., via alook-up of the identifier for the item received at the central servercomputer system 105), and the designation may be made automatically.Thus, the unused multi-use item may be identified and designated byinformation received from any number of sources.

As discussed above, a central server computer system 105 may be incommunication with a number of dispensing devices 120. A patient may beassociated with a dispensing device 120, perhaps based on the locationof his or her room or area, among other factors. A dispensing device 120may include a number of bins allocated as PSBs and ISBs. The multi-usedesignation, along with an associated patient identifier, PSBidentifier, and amount and type information for the medication, may bestored in the data stores 110 by the central server computer system 105.The central server computer system 105 may monitor, track, and directuse of the medications stored in the dispensing devices 120. It is worthnoting that some, or all, of such functions may be off loaded to adispensing device 120 computer.

When an unused item has a multi-use designation, the unused item may bestocked in an ISB, and thus may be available for any of the patientsassociated with the dispensing device 120. For example, an unuseddispenser of eye drops may be stored in an ISB for use of any of thepatients associated with the device. The central server computer system105 may receive data indicating that the unused item will be stored atthe dispensing device 120, and may identify the ISB for storage of theitem. The central server computer system 105 may transmit a first set ofinstruction data directing storage of the unused item in the identifiedISB, or the ISB may be identified by a dispensing device 120 computer.Alternatively, the multi-use item may come directly or indirectly fromthe central dispensing unit 115, and not be placed initially in an ISB.

Therefore, a user may be directed to the ISB by the central servercomputer system 105 or dispensing device 120 computer in response to arequest to obtain the medication. A user (e.g., a nurse, or the patienthimself) may use the previously unused multi-use item stored in the ISB.Information about the use may be input to and processed by thedispensing device 120 computer or other input device. A message may thenbe sent (e.g., from the dispensing device 120 computer) indicating theinitial use by the patient. A second set of instruction data may begenerated, and perhaps transmitted, directing storage of the usedmulti-use item in a PSB assigned to the patient at the dispensing device120. Thus, in response to a received use input or message, the multi-useitem may be assigned to the first patient for exclusive use. The PSBwhere the item is to be stored may be identified after the messageindicating the initial use is received, and this identification may bereceived by a user at the dispensing device 120. PSBs for storage of theused multi-use item may be distinct from single-use medications storedfrom the healthcare facility, and there may be logic preventing themfrom being stored together.

Thus, a set of data may be received (e.g., at the dispensing device 120,or at the central server computer system 105 from a user at thedispensing device 120) that includes a request to obtain the medicationfor administration to the first patient. In response to the request, thecentral server computer system 105 or dispensing device 120 computer maythen automatically identify the location of the multi-use item. Forexample, data stores 110 or other memory may be queried to determinewhether the patient is associated with a used dispenser of themedication at the dispensing device 120 (e.g., in the case when apatient has already used the medication). If no used dispenser of themedication assigned to the patient is available (e.g., it is used up),the ISB storing the unused dispenser of medication may be automaticallyidentified.

After a use of a multi-use item and/or in response to the request toobtain the medication, a determination may be made as to whether thedispenser of medication stored in the PSB for the patient is used up.This determination may be performed with a query to the user, and theresulting response to the query. When it is determined that additionalmedication remains in the dispenser for the patient, the medication maybe excluded from restocking at the PSB. When it is determined that noadditional medication remains in the dispenser for the patient, an ISBmay be identified containing an additional unused dispenser of themedication.

For each used dispenser of medication designated a multi-use item, useof medication may be tracked. Thus, use may be tracked for one or morepatients, for one or more designated multi-use items, and at one or moredispensing devices. In this way, certain restocking thresholds may beset so that enough unused medication of each type will be stored in anISB as it is needed. This tracking and advance restocking may be moresuited to dispensing devices serving a larger number of rooms, tomedications used more regularly, and/or to medications of more criticalimportance to a given set of patients. These factors may each be used tocontrol the threshold restock level.

Threshold restocking levels may be modified based on individual or groupdeterminations. For example, consider a patient who is using a multi-useitem that is deemed to be of critical importance for the well-being ofthe patient, but is used very rarely by other patients. The use of theitem by the patient may be monitored, and the item restocked in an ISBwhen the remaining amount falls below a threshold level (e.g., 25%remaining) that will assure additional stock is available when the itemis depleted. Compare this with patients who are each using a multi-useitem that is used very regularly by other patients. The use of the itemby each of the patients may be monitored, and the items restocked in anISB based on group threshold characteristics. For example, assume thatthere are three patients who will be using an item up at differenttimes. Instead of restocking three different times, there may instead bea single restocking of three items (perhaps with a different threshold).

The designation for multi-use items may be retained for a dispenser ofmedication as a patient is transferred within a healthcare facility, andmay further be retained until the medication is used up. A set of datamay also be received (e.g., at a central server computer system 105 ordispensing device 120 computer) indicating that the patient is to bedischarged from the healthcare facility (perhaps indicating a time orrange of times for the discharge). A determination may be made as towhether the medication remains under an active (or future) medicationorder. Based on the determination, a user (e.g., a nurse or otherdischarge personnel) may be directed to provide the used dispenser ofmedication to the patient upon discharge.

Referring next to FIG. 70, one embodiment of a method 7000 of managingthe storage of multi-use items is illustrated. This method 7000 may, forexample, be performed in whole or in part by the central server computersystem 105 of FIG. 1A or 2. Alternatively, the method 7000 may, forexample, be performed in whole or in part by a computer associated witha dispensing device 120 or 220 of FIG. 1A, 1B, or 2. Also, it is worthnoting that in this and other method embodiments, various steps may beexcluded, and the order may be rearranged.

At block 7005, an unused dispenser of medication is identified which isdesignated as a multi-use medication and stored in an item-specific binavailable to a number of patients at a dispensing device. At block 7010,notice is received of a first use by a patient of the previously unuseddispenser of medication. At block 7015, return of the used dispenser ofmedication is directed to a PSB in the dispensing device and thedispenser is assigned for exclusive use of the patient.

Referring to FIG. 71, an example of a method 7100 of designating andstoring multi-use items is shown. By way of example, this method 7100may be performed in whole or in part by the central server computersystem 105, the computer associated with a dispensing device 120 or 220,or any combination thereof.

At block 7105, a set of data is received identifying an unused dispenserof medication for multiple administrations to a same patient. At block7110, the dispenser of medication is associated with a designationindicating the dispenser of medication is a multi-use item. At block7115, a first set of instruction data is transmitted directing storageof the dispenser of medication in an ISB at a dispensing device. Atblock 7120, a set of use data is received indicating a use of thedispenser of medication by a patient. At block 7125, in response to thereceived set of use data, a second set of instruction data istransmitted directing storage of the used dispenser of medication in aPSB assigned to the first patient at the dispensing device.

Referring to FIG. 72, an example of a method 7200 of differentiating andmanaging multi-use items is shown. This method 7200 may, for example, beperformed in whole or in part by the central server computer system 105,the computer associated with a dispensing device 120 or 220, or anycombination thereof.

At block 7205, a dispenser of medication is designated as a multi-useitem. This designation may be input by a user, or made automaticallybased on a look-up of characteristics of the item. At block 7210,information is received that the multi-use item stored in an ISB is usedfor a patient. This use information may be explicit, or inferred fromdata input by a user (e.g., a nurse) to a dispensing device. Themulti-use item is then associated with the patient at block 7215.

At block 7220, the user (e.g., a nurse who administered the previouslyunused multi-use item to the patient) is automatically directed to a PSBfor storage of the multi-use item, the PSB assigned to the patient. Fora subsequent request for that medication for that patient, the user isdirected to the PSB at block 7225.

After a second use, a determination may be made as to whether themedication is used up at block 7230. If it is determined that themedication is not used up, the process returns to block 7220, where theuser is directed to return the item. Subsequent requests and returns forthe medication will be directed to the PSB until a determination is madethat the medication is used up. Once it is determined that the item isused up, the user may be directed to discard the empty dispenser atblock 7235. Then, a subsequent request for the medication for thepatient may be automatically directed to an ISB storing an unuseddispenser of the medication at block 7240, and the process may revert toblock 7210.

Referring next to FIG. 73, an alternative embodiment of a method 7300 ofmanaging medications with a multi-use designation is shown. As in otherembodiments, this method 7300 may be performed by the central servercomputer system 105, a dispensing device 120 or 220 computer, or anycombination thereof. It is worth emphasizing that the order of the stepsmay be changed, and in certain embodiments steps may be dropped oradded.

At block 7305, an unused dispenser of topical cream medication isidentified (e.g., during a stocking or restocking procedure). At block7310, the dispenser is designated as a multi-use item. The designationmay be automatic, or may be selected by a user (e.g., via a userinterface for the computer integrated with a cabinet). At block 7315,the storage of the dispenser is directed to an ISB at a cabinet (e.g.,the cabinet serving a number of rooms at a healthcare facility)

At block 7320, a request is received from a user (e.g., a nurse) toobtain topical cream medication for a patient associated with thecabinet. For example, the received request may be in the form of aninput by a user at the cabinet, or in the form of a set of dataindicative of the request received from the cabinet. At block 7325, theuser is automatically directed to the ISB storing the unused dispenser.

At block 7330, notice is received that the previously unused dispenserof topical cream is used for the patient. This notice may be in the formof a set of data received from the device, or may be an input from auser. The notice may be implicit or explicit. At block 7335, the useddispenser of topical cream is assigned for exclusive use of the patient.At block 7340, a PSB at the cabinet is assigned to the patient forstorage of the dispenser, the PSB exclusive of single-use items assignedto patient. Items with multi-use designations may be prevented frombeing stored in the same PSB as single-use items. The user may bedirected to the PSB for return of the used dispenser.

At block 7345, the multi-use designation may be retained during atransfer of the dispenser between cabinets (e.g., when there is apatient transfer). At block 7350, a request is received from a user atthe cabinet to obtain topical cream medication for the patient. Again,the received request may be in the form of an input received from a userat the cabinet, or in the form of a set of data including the requestreceived from the cabinet. At block 7355, the user is automaticallydirected to the PSB storing the used dispenser. This may be performed bysending a set of instructions to the cabinet (e.g., sent from a centralserver computer system), or may be performed by the cabinet itself.

At block 7360, a determination is made that the topical cream medicationis not used up, and storage is directed to the PSB. This determinationand direction may be performed locally by the computer integrated withthe cabinet, or received from a remote source (e.g., a central servercomputer system). At block 7365, when a restocking procedure occurs forthe cabinet, the topical cream medication is excluded from restocking atthe PSB based on the multi-use designation.

At block 7370, use of the dispenser of topical cream medication by thepatient is tracked at the PSB. At block 7375, it is determined that thetopical cream use exceeds a threshold (e.g., medication is 75% used up,medication is 90% used up, less than one day's supply remains, less thantwo days' supply remains, etc.). At block 7380, a restock of an unuseddispenser of the topical cream medication is ordered at the ISB. Thisrestock may be done in an attempt to ensure that there is an unuseddispenser for the patient available in an ISB when his topical creammedication runs out.

However, at block 7385, notice of discharge is received before thedispenser of topical cream is used up. This notice may be an input by auser, or perhaps a set of data indicating that a user will be dischargedat a time or range of times. A determination may be made whether theuser remains under an active medication order. At block 7390, a user isdirected to provide the used dispenser to the patient upon discharge.

In one embodiment, the multi-use item may be charged to the patient uponinitial use only, and not charged on a per-application basis.

VIII. Bin Allocation: Various systems, methods, and deviceconfigurations are described for managing the allocation between PSBsand other bins at a dispensing device. The functions described relatedto managing such an allocation may be performed by the central servercomputer system 105 of FIG. 1A or 2, the computer of dispensing device120 or 220 of FIG. 1A. 1B, or 2, or any combination thereof.

In one embodiment, a current bin allocation at a cabinet is identified.This may be performed by identifying those bins at a cabinet allocatedas PSBs and ISBs. Occupancy rates associated with the PSBs aredetermined. These occupancy rates may reflect the current PSB occupancyrate at the cabinet, but may also be based on past and future occupancydata adjusted to the current bin allocation. As these PSB occupancyrates increase, the ability of a user to store medications in PSBs maybe adversely affected. Certain occupancy rates may trigger are-allocation of bins at the device, increasing the allocation of PSBs.Alternatively, such occupancy rates may automatically trigger one ormore messages to a user or cabinet advising re-allocation. In otherembodiments, a message may be sent on a scheduled basis, or be offeredin response to a user inquiry.

The assessment and re-allocation process described herein may occur fora particular dispensing device, set of dispensing devices, or across ahealthcare facility. Thus, although much of following discussion relatesto allocation of PSBs and ISBs at a particular dispensing device, asimilar analysis and allocation may be made for a set of dispensingdevices, or facility wide. Also, while the re-allocation process may bedescribed herein as an automatic bin re-allocation, in other embodimentsthe steps of automated re-allocation may be replaced with an automatedtransmission of a message advising or directing the re-allocation.Therefore, there may be different levels of automation in the process:automated re-allocation, automated re-allocation advisory messages, orautomated messages in response to user inquiries.

At a particular dispensing device (e.g., dispensing device 120 of FIG.1A or 1B), assume that there is an existing allocation of ISBs and PSBs.Information regarding a current bin allocation at a device may becollected and stored by the central server computer system 105, thedispensing device 120, or any combination thereof. For example, acentral server computer system 105 may identify bins allocated as PSBsand ISBs by querying the dispensing device 120, or by accessing data onsuch allocations stored in data stores 110. This data may reflect thecurrent bin allocation on a real-time, or delayed, basis. The currentbin allocation data may also reflect a type designation of each of thebins at a device (e.g., according to size, storage capacity, controllevels, protected bins, refrigeration capabilities, POM or multi-usedesignations, security levels, etc).

The dispensing device 120 and its bins (e.g., PSBs and ISBs) may bemonitored or queried to determine the current occupancy rate (e.g., viaremote monitoring by a central server computer system 105). Thedispensing device 120 may also transmit data to the central servercomputer system 105 indicating occupancy changes at the device (e.g.,when a user stocks or removes an item). Occupancy data may, but neednot, be categorized for various bin types at the dispensing device 120.In one embodiment, the occupancy rate is calculated by analyzing thepercentage of bins storing one or more items.

Bins may be re-allocated as PSBs or ISBs, or messages may be transmittedadvising such re-allocations, based on current occupancy rates. Forexample, current PSB occupancy rates over a threshold (e.g., 80% or 90%)may trigger this re-allocation or messaging. The re-allocation orre-allocation directives may be performed or advised specifically foreach type of PSB, and the triggering threshold may be different fordifferent types of bins. Typically, ISBs of a given type will bere-allocated as PSBs of the same type, and vice versa. However, inanother embodiment, type designations at bins available forre-allocation (e.g., because of under-utilization) are modified based onthe current higher occupancy rates for bins of different designationtypes. For example, high security bins may be re-allocated as lowersecurity bins and may have security features temporarily disabled.

An analysis may also be performed to estimate a turn-away rate for agiven current occupancy rate. In one embodiment, a turn-away rate is therate at which users will be unable to store medications in PSBs at thedispensing device. Current occupancy rate data may be analyzed in lightof past turn-away data to estimate an impact of the occupancy rate. Theturn-away data may be collected for each type of PSB, or may becollected generally across all PSBs. The turn-away data may be used toset the threshold levels triggering messaging or re-allocation. Thetiming and selection of bins for re-allocation may, therefore, be basedat least in part on the turn-away rate.

In addition to real-time monitoring, bin occupancy may be monitored overtime (e.g., by the central server computer system) to evaluate pastoccupancy rates for PSBs and ISBs at a dispensing device 120. This pastoccupancy rate data may then be stored in data stores 110 and/or thedispensing device 120. The past occupancy rate data may be used tocompute average occupancy rates at PSBs. This average occupancy ratedata may reflect occupancy rates for different bin types. Also, averagepast occupancy rates may be calculated over one or more previous timeperiods, and may illustrate a seasonally adjusted average, an average atcertain times of the day or week, a cabinet-specific average, afacility-wide average, or an otherwise calculated average occupancyrate.

The past occupancy rates may be analyzed to determine a variance inoccupancy rates for the PSBs. This variance may be a variance in theaverage occupancy rate, a day-to-day variance, seasonal variance, avariance within periods, or other measures of variance. The average pastoccupancy rates and the variance measures may be used separately or incombination to determine when and how bins are to be re-allocated at adispensing device.

This past occupancy rate data may also include data indicating the rateof turn-aways (e.g., according to bin type or for a cabinet as a whole)associated with different occupancy rates. It may also assess the effectof the turn-aways (e.g., issues related to being redirected to anothercabinet, time delays in reallocating bins at the dispensing device,etc.). This range of past occupancy rate data may be structured to allowqueries regarding the past allocations of PSBs and ISBs at thedispensing device 120.

In one embodiment, PSBs or ISBs may be re-allocated (or there-allocation advised) based on the past occupancy rate data. Forexample, the current bin allocation may be evaluated in light of pastoccupancy rates. This may be achieved by correlating the current binallocation with past occupancy rates, perhaps adjusted to account fordifferences in the number of patients served, characteristics of thosepatients, and the number of available bins. Those skilled in the artwill recognize that past occupancy rates may be expressed in a number ofways (e.g., as the ratio of PSBs used per patient).

An automatic re-allocation or re-allocation message is triggered, in oneembodiment, when these past PSB occupancy rates exceed a threshold. Thethreshold may be different for different types of bins. Thus, while there-allocation based on past occupancy rates may be performed for PSBsgenerally, it may also be directed to certain types of PSBs. By way ofexample, past occupancy rates may be used to identify historicallyunder-utilized ISBs, and re-allocate them as PSBs.

In addition to current and past occupancy rate data, future patient ormedication information may also be used in the re-allocation (orsuggested re-allocation) of PSBs or ISBs. Information may be analyzedabout new, transferred, or existing patients scheduled to occupy roomsserved by a dispensing device 120. Information on their known medicationorders may be analyzed to determine storage needs (e.g., analyzingmedications from the medication order that will be active during thefuture period). In addition, medications and/or storage needs may beestimated for such patients given their medical conditions. Futureoccupancy rates may be determined based on information gathered forscheduled patients.

In addition, estimates may be made of medications and storage needs offuture unscheduled patients to be served from the dispensing device. Forexample, such estimates may be based on typical needs for the average orestimated number of unscheduled patients to be served from the device.Future occupancy rates may be determined based on these estimates forunscheduled patients.

As set forth above for past and current occupancy rate data, PSBs orISBs may be re-allocated based on the future occupancy rate data, aswell. For example, the current bin allocation may be evaluated in lightof future occupancy rates. An automatic re-allocation is triggered, inone embodiment, when these future PSB occupancy rates exceed a threshold(which may be different for different types of bins).

The re-allocations and suggested re-allocations described herein may bemade immediately without application of any time restraints. However, inone embodiment the re-allocation is scheduled or advised to occur at afuture time (e.g., scheduled to occur for an dispensing device of an ERover a busy weekend). In another embodiment, a re-allocation isscheduled to recur at a number of future times.

In many instances set forth above, ISBs are re-allocated as PSBs.However, it is worth noting that the principles outlined above may beapplied in the reverse direction, as well. For example, when occupancyrates attributed to a current bin allocation indicate that PSBs areunder-utilized while ISBs are over-utilized, PSBs may be re-allocated asISBs.

Turning to FIG. 80, a block diagram illustrates an exampleimplementation of a system 8000 configured to re-allocate bins. In oneembodiment, the functional components are integrated with data stores110-a and the central computer system 105-a of FIG. 1.

Data stores 110-a include a data store 8005-a holding current binconfiguration data for a dispensing device 120-c or set of devices. Datastores 110-a also include a data store 8005-b holding the occupancy ratedata for a dispensing device 120-c or set of devices. The data store8005-b that is storing the occupancy rate data includes data stores forpast occupancy rate data 8005-b-1, current occupancy rate data 8005-b-2,and future occupancy rate data 8005-b-3. Data stores 110-a may receivebin configuration data and occupancy data from dispensing device 120-c.

Data stores 110-a are in communication with a central server computersystem 105-a. The occupancy data (e.g., for a particular dispensingdevice 120 or bin type therein) from data store 8005-b may betransmitted to or accessed from the central server computer system 105.An arbitration unit 8010 within the central server computer system 105may process the received occupancy data, attributing different weightsto past, current, or future occupancy data. Certain aspects of the datamay be filtered out, while other aspects may be weighted more heavily.

The occupancy data, after being processed by the arbitration unit 8010,may be forwarded to a re-allocation unit 8015 within the central servercomputer system 105. The bin configuration data (e.g., for a particulardispensing device 120 or bin type therein) from data store 8005-a may betransmitted to or accessed from the central server computer system 105.The re-allocation unit 8015 may use the received bin configuration data,in conjunction with the weighted occupancy rate data, to determine thetiming and identify the bins for re-allocation.

Although the current bin configuration data store 8005-a, past occupancyrate data store 8005-b-1, current occupancy rate data store 8005-b-2,and future occupancy rate data store 8005-b-3 are shown as components ofdata store 110-a, in other embodiments any subset of this data may bestored locally at a dispensing device 120, or elsewhere. Similarly,although arbitration unit 8010 and re-allocation unit 8015 are shown ascomponents of central server computer system 105, in other embodimentsany subset of this functionality may be performed locally at adispensing device 120, or elsewhere. Thus, data storage and processingfunctions may flow through the systems.

Referring next to FIG. 81, one embodiment of a method 8100 of allocatingbins at a dispensing device is illustrated. This method 8100 may, forexample, be performed in whole or in part by the central server computersystem 105 or the computer of dispensing device 120 or 220 of FIG. 1A,1B, or 2. Also, it is worth noting that in this and in otherembodiments, various steps may be excluded, and the order may berearranged.

At block 8105, a current bin allocation is identified for a dispensingdevice by identifying bins allocated as PSBs and bins allocated as ISBs.At block 8110, occupancy rates associated with the PSBs at thedispensing device are determined. At block 8115, item-specific bins areautomatically re-allocated as PSBs based on the identified current binallocation and the determined occupancy rates.

Referring next to FIG. 82, an example of a method 8200 of allocatingbins at a dispensing device based on current occupancy rates isillustrated. This method 8200 may, for example, be performed by thecentral server computer system 105, a computer of dispensing device 120or 220, or any combination thereof. This method 8200 may be anembodiment of the method 8100 performed with respect to FIG. 81.

At block 8205, current bin allocation is identified for a dispensingdevice by identifying bins allocated as PSBs. At block 8210, currentoccupancy rates associated with the PSBs at the dispensing device aredetermined for each of a number of types of PSBs. At block 8215, anautomatic re-allocation is triggered when current occupancy rates for aselected type of PSB exceed a threshold set for the selected type. Thethreshold occupancy levels may vary for different types of PSBs.

At block 8220, other bins at the dispensing device are automaticallyre-allocated as the selected type of PSB. This re-allocation may be fromnon-PSBs of the selected type designation (i.e., they may be bins of thesame type). This re-allocation may, but need not, be targeted at bintypes (PSBs or non-PSBs) that have low occupancy rates. In oneembodiment, certain bin types may be changed when bins of a given typehave relatively high or low occupancy rates (e.g., bins with highsecurity options may store low security items).

Referring next to FIG. 83, an example of a method 8300 of allocatingbins at a dispensing device based on past occupancy rates isillustrated. This method 8300 may, for example, be performed by thecentral server computer system 105, a computer of dispensing device 120or 220, or any combination thereof. This method 8300 may be anembodiment of the method 8100 performed with respect to FIG. 81.

At block 8305, a current bin allocation is identified for a dispensingdevice by identifying bins allocated as PSBs. At block 8310, pastoccupancy rates are analyzed for a number of previous time periods todetermine an average occupancy rate for the PSBs (e.g., as applied tothe current bin configuration). At block 8315, past occupancy rates areanalyzed for previous time periods to determine a variance in occupancyrates for the PSBs. This variance may be a variance in the averageoccupancy rate, a day-to-day variance, seasonal variance, a variancewithin periods, or other measures of variance.

At block 8320, an estimated turn-away rate at which users will be unableto store medications in PSBs at the dispensing device is analyzed. Inone embodiment, the turn-away rate estimate is based on the averageoccupancy rate and variance. At block 8325, bins are automaticallyre-allocated as PSBs based on the average occupancy rate, the variance,and the turn-away rate in light of the current bin allocation at thedevice. In other embodiments, the weights of each factor may be varieddepending on cabinet, bin, or patient characteristics. Moreover, notethat only a subset of these factors are used in some embodiments.

Turning to FIG. 84, an example of a method 8400 of allocating bins at adispensing device based on future occupancy rates is illustrated. Thismethod 8400 may, for example, be performed by the central servercomputer system 105, a computer of dispensing device 120 or 220, or anycombination thereof. This method 8400 may be an embodiment of the method8100 performed with respect to FIG. 81.

At block 8405, a current bin allocation is identified for a dispensingdevice 120 by identifying bins allocated as PSBs. At block 8410, new,existing, and/or transfer patients are identified who are scheduled tobe served from the dispensing device at a future time period. At block8415, medication orders set to be active for the scheduled patientsduring the future time period are identified. At block 8420,patient-specific storage needs are estimated for the scheduled patientsbased on the active medication orders. Additional patient-specificstorage needs for the scheduled patients may be estimated (e.g., basedon typical needs for patients similar to the scheduled patients).

At block 8425, patient-specific storage needs are estimated forunscheduled patients likely be served from the dispensing device at thefuture time period (e.g., based on typical needs for the average orestimated number of unscheduled patients likely to be served from thedevice). At block 8430, future occupancy rates are estimated for thePSBs at the dispensing device based on the estimated patient-specificstorage needs of scheduled and unscheduled patients. At block 8435, binsare automatically re-allocated as PSBs based on the future occupancyrates.

Turning to FIG. 85, an example of a method 8500 of allocating bins at adispensing device based a combination of past, current, or futureoccupancy rates is illustrated. This method 8500 may, for example, beperformed by the central server computer system 105, a computer ofdispensing device 120 or 220, or any combination thereof. This method8500 may be an embodiment of the method 8100 performed with respect toFIG. 81.

At block 8505, a current bin allocation is identified for a dispensingdevice by identifying bins allocated as PSBs and identifying bin types.This method 8500 may then make use of any subset or weighted combinationof past, current, and/or future occupancy rates for PSBs of the device.

At block 8510, past occupancy rates are analyzed to determine an averageoccupancy rate for the PSBs. This may be an average over a time period,a seasonally adjusted average, an average at certain times of the day orweek, a cabinet-specific average, a facility-wide average, or anotherwise calculated average occupancy rate. At block 8515, pastoccupancy rates are analyzed to determine a variance from averageoccupancy rates for the PSBs.

At block 8520, current occupancy rates are analyzed for the PSBs. Thismay be on a real-time query, or on recent polling data. At block 8525,turn-away rates for the PSBs are estimated in light of the currentoccupancy rates. The turn-away rate is a rate in which a user trying tostore items in a PSB will be unable to store medications in PSBs at thedispensing device.

At block 8530, future occupancy rates are estimated for the PSBs forpatients currently scheduled to be served from the device during afuture time period. At block 8535, future occupancy rates are estimatedfor the PSBs based on storage needs of an estimate of patients to beserved from the device during a future time period, yet who are notcurrently on the schedule.

At block 8540, factors associated with past, current, and futureoccupancy rates are used, with different weights, to determine occupancyrates for different PSB types. At block 8545, bins are automaticallyre-allocated as a first type of PSB for a finite time period beginningat a future time. At block 8550, bins are automatically re-allocated asa second type of PSBs on a recurring basis (e.g., flip-flopping betweenPSB and ISB allocation at certain times of the day). Any of theautomated re-allocation, as described with reference to FIGS. 81-85 may,instead be an automated transmission of a re-allocation message todirect re-allocation to a user, the dispensing device, or the centralserver computer system.

A device structure 9000 that may be used for a central server computersystem 105 of FIG. 1A or 2, the computer of the patient dispensingdevice 120 or 220 of FIG. 1A, 1B, or 2, the computer of the centraldispensing unit 115 of FIG. 1A or 1B, or other computing devices orfunctional or processing units described herein, is illustrated with theschematic diagram of FIG. 90. This drawing broadly illustrates howindividual system elements of each of the aforementioned devices may beimplemented, whether in a separated or more integrated manner.

The example structure is shown made up of hardware elements that areelectrically coupled via bus 9005, including processor(s) 9010 (whichmay be, or may include, a DSP or special-purpose processor), storagedevice(s) 9015, input device(s) 9020, and output device(s) 9025. Thestorage device(s) 9015 may be a machine-readable storage media readerconnected to any machine-readable storage medium, the combinationcomprehensively representing remote, local, fixed, or removable storagedevices or storage media for temporarily or more permanently containingcomputer-readable information. The communications systems interface 9045may interface to a wired, wireless, or other type of interfacingconnection that permits data to be exchanged with other devices. Thecommunications system(s) 9045 may permit data to be exchanged with anetwork. There may also be a GPS or other location based receiver 9050,configured to transmit location information about a device that may beleveraged for various purposes.

The structure 9000 may also include additional software elements, shownas being currently located within working memory 9030, including anoperating system 9035 and other code 9040, such as programs orapplications designed to implement methods of the invention. It will beapparent to those skilled in the art that substantial variations may beused in accordance with specific requirements. For example, customizedhardware might also be used, or particular elements might be implementedin hardware, software (including portable software, such as applets), orboth. Thus, any functionality described herein may be implemented withone or more Application Specific Integrated Circuits (ASICs) adapted toperform some or all of the applicable functions in hardware.Alternatively, the functions may be performed by one or more otherprocessing units (or cores), on one or more integrated circuits. Inother embodiments, other types of integrated circuits may be used (e.g.,Structured/Platform ASICs, Field Programmable Gate Arrays (FPGAs) andother Semi-Custom ICs), which may be programmed in any manner known inthe art.

It should be noted that the methods, systems and devices discussed aboveare intended to be interpreted as examples only. It must be stressedthat various embodiments may omit, substitute, or add various proceduresor components as appropriate. For instance, it should be appreciatedthat in alternative embodiments, the methods may be performed in anorder different than that described, and that various steps may beadded, omitted or combined. Also, features described with respect tocertain embodiments may be combined in various other embodiments.Different aspects and elements of the embodiments may be combined in asimilar manner. Also, it should be emphasized that technology evolvesand, thus, many of the elements are examples and should not beinterpreted to limit the scope of the invention.

Specific details are given in the description to provide a thoroughunderstanding of the embodiments. However, it will be understood by oneof ordinary skill in the art that the embodiments may be practicedwithout these specific details. For example, well-known circuits,processes, algorithms, structures, and techniques have been shownwithout unnecessary detail in order to avoid obscuring the embodiments.

Also, it is noted that the embodiments may be described as a processwhich is depicted as a flowchart, a flow diagram, a structure diagram,or a block diagram. Although a flowchart may describe the operations asa sequential process, many of the operations can be performed inparallel or concurrently. In addition, the order of the operations maybe rearranged. A process is terminated when its operations arecompleted, but could have additional steps not included in the figure.

Moreover, as disclosed herein, the term “memory” may represent one ormore devices for storing data, including read-only memory (ROM), randomaccess memory (RAM), magnetic RAM, core memory, magnetic disk storagemediums, optical storage mediums, flash memory devices or othermachine-readable mediums for storing information. The term“machine-readable medium” includes, but is not limited to, portable orfixed storage devices, optical storage devices, wireless channels, a simcard, other smart cards, and various other mediums capable of storing,containing or carrying instructions or data.

Furthermore, embodiments may be implemented by hardware, software,firmware, middleware, microcode, hardware description languages, or anycombination thereof. When implemented in software, firmware, middlewareor microcode, the program code or code segments to perform the necessarytasks may be stored in a machine-readable medium such as a storagemedium. Processors may perform the necessary tasks.

Having described several embodiments, it will be recognized by those ofskill in the art that various modifications, alternative constructions,and equivalents may be used without departing from the spirit of theinvention. For example, the above elements may merely be a component ofa larger system, wherein other rules may take precedence over orotherwise modify the application of the invention. Also, a number ofsteps may be required before the above elements are considered.Accordingly, the above description should not be taken as limiting thescope of the invention.

1. A system for designating an item as a patient's own medication, thesystem comprising: a plurality of dispensing devices for medications;and a central server computer system, communicatively coupled to atleast a subset of the plurality of dispensing devices, and configuredto: receive a set of data identifying medication brought to a healthcarefacility by a patient; designate the medication as the patient's ownmedication; automatically retain the designation for the medication whenthe patient is transferred from a first location to a second location atthe healthcare facility; and automatically identify the medication as anitem to be returned to the patient when the patient is discharged fromthe healthcare facility, the identification based at least in part onthe designation.
 2. The system of claim 1, wherein the medication ismoved from a first one of the plurality of dispensing devices to asecond one of the plurality of dispensing devices when the patient istransferred, and the designation is automatically retained during themove.
 3. The system of claim 1, wherein the central server computersystem is further configured to: exclude an item designated as thepatient's own medication from restocking until the item is used up. 4.The system of claim 1, wherein the central server computer system isfurther configured to: determine that supply of the medicationdesignated as the patient's own medication is used up; direct restockingof the medication based at least in part on the determination; andremove the designation from the medication.
 5. The system of claim 1,wherein the central server computer system is further configured to:determine that the designated medication is prescribed for the patientunder an active medication order, wherein the automatic identificationis based at least in part on the determination.
 6. The system of claim1, wherein the central server computer system is further configured to:determine that a second medication is not prescribed for the patientunder an active or future medication order; and direct a user to retainthe second medication after the discharge.
 7. The system of claim 1,wherein the central server computer system is further configured to:associate a selected one of the plurality of dispensing devices with thepatient, the selected dispensing device including a first set of one ormore patient-specific bins for exclusive use of the patient formedication stocked from the healthcare facility; and assign a second setof one or more bins at the selected dispensing device to the patient forthe designated medication, the second set distinct from the first set.8. The system of claim 7, wherein the central server computer system isfurther configured to: apply a first set of restocking rules formedication stocked from the healthcare facility; and apply a second setof restocking rules for the designated medication.
 9. The system ofclaim 8, wherein the central server computer system is furtherconfigured to: apply a same set of additional rules for both themedication stocked from the healthcare facility and the designatedmedication, wherein the additional rules comprise a selection from agroup consisting of allergy rules, contraindication rules, storagesecurity requirement rules, and any combination thereof.
 10. The systemof claim 7, wherein the central server computer system is furtherconfigured to: identify items designated as the patient's ownmedication; and prevent assignment of the identified items to binsassigned for medication stocked from the healthcare facility.
 11. Thesystem of claim 7, wherein the medication stocked from the healthcarefacility and the medication designated as the patient's own medicationare the same type of medication.
 12. The system of claim 11, wherein thecentral server computer system is further configured to: avoid directinguse of the medication stocked from the healthcare facility until thepatient's own medication is used up.
 13. A method of managing apatient's own medication, the method comprising: receiving a set of dataidentifying medication brought to a healthcare facility by the patient;designating the medication as the patient's own medication;automatically retaining the designation for the medication when themedication is transferred from a first one of a plurality of dispensingdevices to a second one of the plurality of dispensing devices at thehealthcare facility; and automatically identifying the designatedmedication as an item to be returned to the patient when the patient isdischarged from the healthcare facility, the identification based atleast in part on the designation.
 14. The method of claim 13, whereinthe patient is transferred from a first location to a second locationwhen the designated medication is moved, and the designation isautomatically retained during the transfer.
 15. The method of claim 13,further comprising: preventing a medication designated as the patient'sown medication from being restocked until the item is used up; directingrestocking of the medication based at least in part on a determinationthat the designated medication is used up; and removing the designationfrom the medication.
 16. The method of claim 13, further comprising:determining that the designated medication is prescribed for the patientunder a current medication order, wherein the automatic identificationis based at least in part on the determination.
 17. The method of claim13, further comprising: associating a selected one of a plurality ofdispensing devices with the patient, the selected dispensing deviceincluding a first set of one or more patient-specific bins for exclusiveuse of the patient for medication stocked from the healthcare facility;and assigning a second set of one or more bins at the selecteddispensing device to the patient for the designated medication, thesecond set distinct from the first set.
 18. The method of claim 13,further comprising: applying different restocking rules to medicationstocked from the healthcare facility than to the designated medication.19. The method of claim 13, further comprising: applying a same set ofrules for both the medication stocked from the healthcare facility andthe designated medication, wherein the set of rules comprises aselection from a group consisting of safety rules, storage securityrequirement rules, and any combination thereof.
 20. The method of claim13, further comprising: identifying items designated as the patient'sown medication; and preventing assignment of the identified items tobins assigned for medication stocked from the healthcare facility. 21.The method of claim 13, further comprising: suspending use of themedication stocked from the healthcare facility until the patient's ownmedication is used up, wherein the medication stocked from thehealthcare facility and the medication designated as the patient's ownmedication are the same type of medication.
 22. A method of managing apatient's own medication, the method comprising: receiving a set of dataidentifying medication brought to a healthcare facility by the patient;designating the medication as the patient's own medication; receivingnotice of a patient transfer from a first location to a second locationat the healthcare facility; transmitting, in response to the notice,data directing the move of the designated medication from a firstdispensing device associated with the first location to a seconddispensing device associated with the second location; and automaticallyretaining the designation for the designated medication during the move.23. The method of claim 22, further comprising: receiving notice thatthe patient is to be discharged from the healthcare facility; andtransmitting, in response to the notice, data directing return of thedesignated medication to the patient.
 24. A method of managing apatient's own medication, the method comprising: receiving a set of dataidentifying medication brought to a healthcare facility by the patient;designating the medication as the patient's own medication; associatethe patient with a selected one of a plurality of dispensing devices,the selected dispensing device including a first set of one or morepatient-specific bins assigned for exclusive use of the patient formedication stocked from the healthcare facility; assign a second set ofone or more patient-specific bins at the selected dispensing device tothe patient for the designated medication, the second set distinct fromthe first set; receiving notice of a patient discharge from thehealthcare facility; and transmitting, in response to the notice, datato the selected dispensing device directing return of the designatedmedication to the patient.
 25. The method of claim 24, furthercomprising: transmitting, in response to the notice, data to theselected dispensing device directing retention of the medication in thefirst set of one or more patient-specific bins.